Septic Peritonitis from Ruptured Pyometra: Case Report and Literature Review

Area of Science:

• Gynecology
• Emergency Medicine
• Radiology

Background:

• Pyometra, characterized by pus in the uterine cavity due to cervical obstruction, is infrequent in postmenopausal women.
• Spontaneous uterine rupture from pyometra is an exceptionally rare event, potentially leading to severe peritonitis and sepsis.

Purpose of the Study:

• To report a rare case of a ruptured pyometra in a postmenopausal woman.
• To emphasize the diagnostic challenges and the utility of imaging in suspected cases.
• To highlight the critical role of early surgical intervention and antibiotic therapy.

Main Methods:

• A case report of a 57-year-old postmenopausal woman presenting with symptoms of ruptured pyometra.
• Diagnostic workup included ultrasound and contrast-enhanced computed tomography (CT).
• Treatment involved urgent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal lavage, and broad-spectrum antibiotics.

Main Results:

• The patient presented with fever, hypotension, abdominal pain, and foul vaginal discharge.
• CT revealed an endometrial fluid collection with a posterior uterine wall defect communicating with the peritoneal cavity.
• Laparotomy identified approximately 1500 mL of purulent ascites and a 3.0-cm uterine perforation; histopathology confirmed necrotizing endometritis/pyometra without malignancy.

Conclusions:

• Ruptured pyometra presents a diagnostic challenge, often mimicking other acute abdominal conditions.
• Contrast-enhanced CT is valuable for diagnosing uterine rupture when suspected.
• Prompt surgical source control combined with appropriate antibiotic therapy is essential for favorable outcomes in ruptured pyometra.