Perforative Peritonitis-Gastrointestinal Tract May Not Always Be the Source.

Area of Science:

• General Surgery
• Gynecology
• Emergency Medicine

Background:

• Perforative peritonitis is a common surgical emergency, typically caused by gastrointestinal perforation.
• Rarely, peritonitis can result from spontaneous uterine perforation, a condition with fewer than 50 reported cases.
• Uterine perforation can occur after intrauterine procedures, potentially injuring adjacent organs.

Purpose of the Study:

• To report two rare cases of spontaneous perforation of the non-gravid uterus.
• To highlight the clinical presentation of spontaneous uterine perforation in elderly postmenopausal women.
• To emphasize the diagnostic challenge posed by spontaneous uterine perforation, which can mimic gastrointestinal perforation.

Main Methods:

• Case report presentation of two elderly postmenopausal women.
• Clinical evaluation for generalized peritonitis.
• Surgical intervention and diagnosis confirmation.

Main Results:

• Both patients presented with generalized peritonitis, clinically indistinguishable from gastrointestinal perforation.
• Spontaneous perforation of the non-gravid uterus was confirmed as the cause in both cases.
• The patients were elderly postmenopausal women, a demographic not typically associated with this condition.

Conclusions:

• Spontaneous uterine perforation is a rare but critical differential diagnosis in patients presenting with peritonitis, especially in elderly women.
• Clinical presentation can be misleading, necessitating a high index of suspicion.
• Prompt surgical management is essential for favorable outcomes.