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Dienogest Use for Recurrent Pyosalpinx as a Long-Term Complication of Cloacal Exstrophy: A Case Report

Yoshimura, Shohei Okata, Yuichi Iwabuchi, Serena Watanabe, Aya Uemura, Kotaro Tomioka, Yuichiro Samejima, Yoshitomo Bitoh, Yuko 神戸大学

2023.06

概要

Background Cloacal exstrophy (CE) is a rare congenital disease that requires multiple surgeries for complex gastrointestinal and genitourinary anomalies. Long-term complications are not uncommon; however, they are poorly reported. Pyosalpinx is sometimes encountered during CE management in adolescents and young adults. Case A 28-year-old woman with a history of CE presented with fever, lower abdominal pain, and vomiting and was diagnosed with left pyosalpinx. Computed tomography-guided drainage and intravenous antibiotic administration were successful; however, she had 2 readmissions for recurrent pyosalpinx 1 week after discharge and again 4 months later. She was administered Dienogest, a synthetic progestin, to prevent recurrent pyosalpinx and had no recurrence for 8 months. Summary and Conclusion Dienogest is a conservative treatment choice for preventing the recurrence of pyosalpinx for patients with CE.

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Figure 1 Enhanced abdominal CT findings at diagnosis

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A: Axial imaging showing a 79×52 mm left pyosalpinx on the back of the bladder and

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multiple small abdominal abscesses.

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B: The coronal imaging revealed bilateral hydronephrosis associated with compression

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by the pyosalpinx.

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CT, computed tomography.

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Figure 2 Abdominal US findings before and after DNG administration

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A: Before DNG administration, abdominal US showed left hydrosalpinx and suspected

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B: Under DNG administration, no fluid collection in the left fallopian tube was observed

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