Generalized peritonitis secondary to spontaneously perforated pyometra in elderly women:two cases with different clinical courses and surgical approaches and review of the literature

Abstract

We describe two cases of spontaneously perforated pyometra (SPP) in elderly women treated with two different surgical approaches. An 88-yearold woman underwent emergency laparotomy for presumed diagnosis of gastrointestinal (GI) tract perforation. During surgery, SPP and a tumor of the sigmoid colon were identified. Total hysterectomy and sigmoid colon resection were performed. Despite exhaustive postoperative treatments, the patient died on postoperative day (POD) 189 due to peritonitis and pneumonia. A 93-yearold woman with acute abdomen was diagnosed with severe pyometra and primarily treated with transcervical drainage. Due to progression of generalized peritonitis, laparoscopic surgery was performed. Intraoperatively, scar from a uterine body perforation was identified, leading to the diagnosis of SPP. Only peritoneal irrigation and drainage were performed, in consideration of her advanced age. She improved and was discharged from the hospital on POD 35. The prognosis for SPP is sometimes poor, especially in older women. Minimally invasive surgical intervention might be considered for primary treatment in such cases.

Minimally invasive management of pyoperitoneum attributed by spontaneous perforated pyosalpinx and pyometra

“…4 The most common organisms isolated are Streptococcus species, Bacteroides fragilis and Escherichia coli. 2 Spontaneous perforation of pyometra is an extremely rare complication. It is associated with severe consequences, resulting in 25-40% mortality.…”

“…1 Pyometra, an accumulation of pus in the uterine cavity, has a 0.1-0.5% incidence in the general population, typically in postmenopausal females, mostly attributed to age-related atrophic cervicitis, gynecologic tumours (malignant/benign), radiation cervicitis, and intrauterine devices. 2 The clinical appearance ranges from a pelvic mass to peritonitis with septic shock. Pyoperitoneum is generally managed surgically by laparotomy or laparoscopy.…”

Spontaneous uterine perforation of pyometra leads to acute abdominal pain and septic shock: a case report

“…The treatment of spontaneous uterine perforation of pyometra includes broad-spectrum antibiotics against aerobic and anaerobic conditions and timely medical intervention. [7] Hysterectomy is the typical choice, but in some cases, a total hysterectomy with bilateral salpingo-oophorectomy is needed. To support the patient postoperatively, it is critical to have thorough drainage of the pelvic cavity, as well as intensive care.…”

A Case of Pyometra Caused by Achromobacter xylosoxidans and γ-Streptococcus in an Elderly Frail Woman

“…Given all these findings, pyometra should be considered in older women with a fever of unknown origin. Imaging studies and gynecological consultation should be requested promptly, as a delayed diagnosis can lead to pan-peritonitis and septic shock due to perforation of the uterus [ 13 , 14 ].…”