Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint – abdominal pain. Risk factors include gynecological malignancy and postmenopausal status. A pyometra is a collection of pus enlarging the uterine cavity. This mainly happens when there is cervical stenosis, usually due to malignancy of the uterus or cervix and treatment with radiotherapy. However, other causes of pyometra include: Fibroid degeneration; Endometrial polyps, endometrial carcinoma; Cervical occlusion after surgery (eg prolapse surgery, endometrial ablation); Senile cervicitis; Puerperal infections; Uterine compression sutures used for postpartum hemorrhage to avoid hysterectomy; Congenital cervical anomalies; Forgotten intrauterine device; Genital tuberculosis; Radiotherapy; After egg retrieval in in vitro fertilization. Pyometra is a rare disease with a reported incidence of 0.01-0.5% of patients with gynecological complaints. However, it is more common in older women, postmenopausal women, usually with co-morbidities. Pyometria can exist without symptoms and is discovered as an incidental finding on imaging. Symptoms and signs may include: Blood-stained purulent vaginal discharge; Symmetrical enlargement of the uterus; Pain in the lower abdomen; Pyrexia. Extremely rarely, the pyometra spontaneously perforates and the symptomatology of the condition is presented with a picture of an acute surgical abdomen. Research features may be indistinguishable from other causes of peritonitis. Hysterectomy may be recommended in some cases, but many women are treated conservatively with cervical dilatation and drainage of the pus collection, with regular monitoring for recurrent or persistent disease. Increasingly, interventional radiology can offer an alternative to surgery. Antibiotic treatment is necessary only if there is evidence of invasive infection in the form of generalized malaise, pyrexia, or altered laboratory parameters. Tuberculous pyometra should be treated with appropriate antituberculous chemotherapy. Spontaneous perforation is one of the complications of the condition and seems more likely when there has been a delay in treatment. Hypoalbuminemia is a predisposing factor for pyometra perforation. Prognosis depends on both the underlying cause (eg, malignancy) and whether or not spontaneous perforation has occurred. Prompt recognition and treatment of the condition greatly improves the prognosis. References: 1. Toglia MR, Fagan MJ; Pyometra complicating a LeFort colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct. 2. Schlumbrecht M, Balgobin S, Word L; Pyometra after thermal endometrial ablation. Obstet Gynecol. 3. Yildizhan B, Uyar E, Sismanoglu A, et al; Spontaneous perforation of pyometra. Infect Dis Obstet Gynecol. 4. Hofmann GE,Warikoo P, Jacobs W; Ultrasound detection of pyometra at the time of embryo transfer after ovum retrieval for in vitro fertilization. Fertil Steril.