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Spontaneously perforated pyometra presenting as diffuse peritonitis: report of a case
H Kimura1, H Sodani, H Takamura
1Department of Gastroenterology, Keiju Hospital, Ishikawa, Japan.
Abstract:
We report herein a rare case of spontaneously perforated pyometra found in a 72-year-old woman who was admitted to our hospital with abdominal pain and vomiting. A distended abdomen with muscular rigidity, a positive Blumberg sign, and a WBC count of 11,900/mm3 indicated diffuse peritonitis, although a plain abdominal X-ray film revealed no free air in the peritoneal cavity. An emergency laparotomy was performed, which revealed a lot of pus, and perforation in the fundus of a distended uterus. The patient was therefore diagnosed as having suffered uterine perforation associating with a pyometra, and a total hysterectomy with bilateral salpingo-oophorectomy was carried out. Histological examination revealed a pyometra with inflammation and destruction of the endometrium and myometrium, and cervical occlusion with no evidence of malignancy. Postoperatively, the patient developed a subcutaneous abscess and pneumonia, but recovered and was discharged on the 74th day after her operation. Thus, although rare, spontaneously perforated pyometra should be considered when elderly women present with acute abdominal symptoms.
Insights
This case report details a rare instance of spontaneously perforated pyometra in an elderly woman presenting with acute abdominal symptoms. Prompt surgical intervention was crucial for managing this life-threatening condition.
Area of Science:
- Gynecology
- Emergency Medicine
- Surgical Pathology
Background:
- Pyometra, a rare condition characterized by pus accumulation within the uterus, typically affects postmenopausal women.
- Spontaneous uterine perforation is an uncommon but severe complication of pyometra.
Observation:
- A 72-year-old woman presented with acute abdominal pain and vomiting, exhibiting signs of diffuse peritonitis.
- Initial imaging did not reveal free air, complicating the diagnosis of uterine perforation.
Findings:
- Emergency laparotomy confirmed a distended uterus with pus and a perforation in the fundus, diagnosing spontaneously perforated pyometra.
- Histological examination showed endometrial and myometrial destruction with cervical occlusion, excluding malignancy.
Implications:
- This case underscores the importance of considering spontaneously perforated pyometra in the differential diagnosis of acute abdominal conditions in elderly women.
- Early recognition and surgical management, including hysterectomy, are vital for favorable outcomes in such rare cases.