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

Abstract

Background: Although spontaneous perforation of pyometra is very rare, it sometimes causes severe peritonitis, leading to lethal conditions. Damage control surgery reportedly improves the survival of critically ill patients; however, there has been no report describing damage control surgery for ruptured pyometra.Case presentation: An 83-year-old postmenopausal woman with generalized peritonitis and septic shock was admitted and underwent emergency laparotomy. Abbreviated surgery was carried out because of progressing septic shock, and planned reoperation was carried out 2 days after the initial surgery. Histopathological examination revealed the perforation of pyometra with no evidence of malignancy. The patient was discharged on the 32nd postoperative day in stable condition. Conclusion:We report a case of spontaneous perforation of pyometra with severe septic shock successfully treated by damage control surgery. Damage control surgery is a useful treatment option for hemodynamically unstable patients with diseases in the field of obstetrics and gynecology.

Effective Use of the Hybrid Emergency Room System in the Treatment of Patients with Non-Traumatic Critical Care Diseases: a retrospective, observational study

“…The effectiveness of DCS in trauma care has already been reported in many cases [8,10,12,21,22]. Additionally, we have reported the effectiveness of DCS for intra-abdominal infections that present with septic shock [23]. However, the present results show that only a small number of patients admitted to the hybrid ER underwent surgery in the hybrid ER.…”

Management of Pyometra Using a Novel Image-Guided Percutaneous Technique: A Case Report

“…In contrast, potential complications of pyometra can be catastrophic, including spontaneously perforated pyometra [4][5][6][7]9,10], with subsequent development of bacteraemia [8], generalised peritonitis [5,6], pneumoperitoneum [10], and septic shock [21].…”

Spontaneous perforation of pyometra—is hysterectomy required in the emergent setting? A case report and literature review

“…However, in the absence of clear evidence of malignancy, the role of either simple hysterectomy or TAH + BSO becomes less clear, particularly in the emergent setting. Some authors have advocated for the use of damage control principles in patients with severe septic shock [ 9 ]. Our patient demonstrated signs of severe sepsis at presentation; however, she became stable enough to allow for extensive exploration of both the peritoneal cavity and uterine cavity.…”

“…Matsumoto et al . [ 9 ] described performing a TAH + BSO in a delayed fashion after initially stabilizing their patient with abbreviated surgery. However, in our case histopathology revealed no evidence of malignancy, and as a result hysterectomy was not pursued, thus eliminating the morbidity associated with this procedure.…”