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Postmenopausal spontaneous rupture of pyometra: A case report
1Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China.
Medicine
|December 30, 2018
Summary
Spontaneous perforation of pyometra is a rare gynecological emergency. This case highlights the diagnostic challenges and successful surgical management of a 72-year-old woman with perforated pyometra presenting as peritonitis.
Area of Science:
- Gynecologic Surgery
- Emergency Medicine
- Abdominal Peritonitis
Background:
- Spontaneous perforation of pyometra is a rare but life-threatening gynecological condition with high mortality.
- Clinical presentation often mimics gastrointestinal perforation, complicating preoperative diagnosis due to subtle gynecological symptoms.
Observation:
- A 72-year-old woman presented with acute abdominal pain, purulent vaginal discharge, diffuse peritonitis, and shock.
- Emergency laparotomy revealed approximately 1000 mL of pus in the abdominal cavity originating from the uterus, with a 1.5 cm perforation on the posterior uterine wall.
Findings:
- Diagnosis of spontaneous perforation of pyometra was confirmed intraoperatively.
- The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy.
- Histopathology confirmed purulent uterine inflammation without malignancy.
Implications:
- While ultrasonography is sensitive for pyometra, diagnosing perforation requires advanced imaging like CT scans and MRI.
- Prompt surgical intervention is crucial for managing perforated pyometra presenting as acute abdomen.
- This case underscores the importance of considering rare gynecological emergencies in patients with peritonitis.
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