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Background: This case report describes an uncommon complication of generalized peritonitis following spontaneous perforation of pyometra. Case: A 60-year-old postmenopausal woman presented with clinical features of acute abdomen, and she was later diagnosed with pyometra perforation after a computed tomography scan. Laparotomy was performed, followed by a total abdominal hysterectomy with a bilateral salpingo-oopherectomy. Results: The patient died on her third postoperative day. Conclusions: Spontaneous pyometra perforation is a rare clinical condition; yet, it should be suspected and kept in the differential diagnosis of acute abdomen in elderly women. ( J GYNECOL SURG 28:234)

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Background: Appendicectomy is the most common emergency abdominal surgery. It can be an open appendicectomy or a laparoscopic one. Laparoscopic appendectomies are preferred to open surgery for simple appendicitis, but most of the advantages are of limited clinical relevance. It has gained popularity in recent years however; it has not become the universal gold standard for acute appendicitis as laparoscopic cholecystectomy has become for cholelithiasis. Results: A total of 125 patients were treated for appendicitis during this period with a male female ratio of 1:1.36. Most common age group was the 2nd decade with mean age being 20 years, while most common symptom was abdominal pain. Ultrasonography showed evidence of acute appendicitis in 85.6% and leucocytosis in 66.4% cases. Although only 5.6% of appendices grossly appeared normal during surgery, histopathology showed 14.4% to be normal. Wound sepsis (24.8%) was the most common post-operative complication. Conclusion: Diagnosis of acute appendicitis in our setting is still based on high index of suspicion following clinical evaluation. Combining this with laboratory findings and ultrasound scan has yielded an acceptable negative appendicectomy rate. We advocate routine use of ultrasound along with clinical evaluation and laboratory tests for the timely diagnosis of acute appendicitis and an early surgical intervention to prevent complications.