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Spontaneous perforated pyometra presenting as pneumoperitoneum

Y Ikematsu¹, T Kitajima, Y Kamohara

¹Department of Surgery, Nagasaki Municipal Hospital, Japan.

Gynecologic and Obstetric Investigation

|January 1, 1996

Summary

Spontaneous perforated pyometra, a rare cause of pneumoperitoneum, was observed in an elderly female. This case highlights the importance of considering uterine conditions in acute abdominal emergencies.

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Area of Science:

Gynecology
Emergency Medicine
Radiology

Background:

Spontaneous perforated pyometra is an exceptionally rare condition.
Pneumoperitoneum as a presentation of uterine pathology is uncommon, particularly in elderly patients.

Observation:

An 80-year-old female presented with severe abdominal pain and signs of an acute abdomen.
Initial imaging revealed pneumoperitoneum, leading to a presumptive diagnosis of gastrointestinal perforation.
Laparotomy unexpectedly disclosed a perforated pyometra as the source of free air.

Findings:

The patient underwent a simple hysterectomy.
Histological examination confirmed acute endometritis without evidence of malignancy.
This represents the third reported case of spontaneous perforated pyometra presenting with pneumoperitoneum.

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Implications:

Perforated pyometra should be included in the differential diagnosis for elderly patients with an acute abdomen and pneumoperitoneum.
Prompt recognition and surgical intervention are crucial for managing this rare but serious condition.