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Damage control surgery for spontaneous perforation of pyometra with septic shock: a case report

Ryo Matsumoto1, Shunsuke Kuramoto1, Tomohiro Muronoi1

  • 1Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan.

Acute Medicine & Surgery
|May 24, 2021
PubMed
Abstract

Insights

Spontaneous pyometra perforation is rare but life-threatening. Damage control surgery offers a viable treatment for critically ill patients with ruptured pyometra and septic shock, improving survival rates.

Area of Science:

  • Obstetrics and Gynecology
  • Surgical Critical Care

Background:

  • Spontaneous pyometra perforation is a rare obstetric and gynecologic emergency.
  • It can lead to severe peritonitis and septic shock, often with lethal outcomes.
  • Damage control surgery (DCS) is established for critically ill patients but not reported for ruptured pyometra.

Observation:

  • An 83-year-old postmenopausal woman presented with generalized peritonitis and septic shock.
  • Emergency laparotomy revealed a ruptured pyometra.
  • Abbreviated surgery due to hemodynamic instability was followed by planned reoperation.

Findings:

  • Histopathological examination confirmed pyometra perforation without malignancy.
  • The patient's septic shock and peritonitis were managed through staged surgical intervention.
  • Successful treatment with damage control surgery was achieved.

Implications:

  • Damage control surgery is a potentially life-saving option for hemodynamically unstable patients with ruptured pyometra.
  • This case highlights the utility of DCS in gynecologic emergencies.
  • Further research into DCS for gynecologic conditions is warranted.
Keywords:
Case reportelderly womanemergency surgeryopen abdomen managementperitonitis

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