A Text-book of Diseases of Women

by Charles B. Penrose

ACUTE CORPOREAL ENDOMETRITIS.

Acute inflammation of the mucous membrane of the body of the uterus is called acute corporeal endometritis. The disease is usually the result of septic infection occurring at a labor or a miscarriage. Occasionally acute gonorrheal endometritis is seen, but this disease usually produces an inflammation of the mucous membrane of the cervix and the body of the uterus that is chronic or subacute from the beginning. Septic infection through operative traumatism, through the use of the uterine sound, or through other gynecological methods of examination may, of course, result in acute endometritis.

The pathological changes that take place in an endometrium that is the seat of acute inflammation resemble those seen in acute inflammation of mucous membranes of other parts of the body. The secretion of the utricular glands becomes much increased in quantity and altered in character, becoming purulent and sometimes containing blood.

As would be expected, whenever the inflammation is at all severe the middle or muscular coat of the uterus is involved by the process; in other words, a metritis follows and accompanies the endometritis. In puerperal metritis abscesses varying in size from a pin-head to that of a hen’s egg are sometimes found in the uterine wall.

The septic infection may extend through the muscular wall of the uterus and involve the peritoneal covering, producing in this way a perimetritis.

Acute inflammation of the endometrium sometimes occurs during the course of the exanthemata. The changes that take place in the mucous membrane of the uterus are similar to those seen in other mucous membranes during the course of these diseases. The local condition is usually limited by the duration of the general disease.

It is probable that some of the cases of arrested development of the internal organs of generation, and cases of chronic tubal and ovarian disease seen in later life, may be traced to this exanthematous form of endometritis occurring during girlhood.

The symptoms of acute endometritis vary very much in severity. Dull pain in the region of the uterus, referred to the supra-pubic region and the sacrum, is usually present. Reflex disturbance of the bladder, characterized by frequent and often painful urination, may be present; and it is very probable that mild cases of endometritis have been diagnosed and treated as light attacks of cystitis. The temperature in the puerperal cases may be very high. The discharge from the cervix is very much increased, is puriform in character, and is occasionally streaked with blood.

Digital examination shows that the external os is patulous, the cervix enlarged and soft, and the body of the uterus somewhat enlarged and tender upon pressure. This tenderness may be elicited by pressing the fundus between the vaginal finger in the anterior vaginal fornix and the abdominal hand. Examination through the speculum shows the discharge escaping from the external os. In case the cervical mucous membrane is also involved, a red area of erosion will be seen surrounding the os.

Acute endometritis of non-puerperal origin is best treated by rest in bed, vaginal douches of hot boric-acid solution (ʒj to a pint of water) or of bichloride of mercury (1:4000) at a temperature of 100° to 110°, and the continuous use of saline purgatives. Active intra-uterine treatment in these cases is not necessary. When, however, the disease occurs, as it usually does, from septic infection at a miscarriage or a labor, more radical treatment must be used. This treatment comprises frequently-repeated intra-uterine douches, thorough curetting of the uterus, and, finally, hysterectomy in extreme cases.