Generalized peritonitis with pneumoperitoneum caused by the spontaneous perforation of pyometra without malignancy: Report of a case

Abstract

Spontaneous perforation is a very rare complication of pyometra. We report herein the case of an 88-year-old woman who presented with muscular rigidity and free air on abdominal X-ray films. Perforation of the gastrointestinal tract was diagnosed preoperatively, and an emergency laparotomy was performed. A total hysterectomy with bilateral salpingo-oophorectomy was carried out under the diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra. The culture of purulent fluid from the abdominal cavity showed only Escherichia coli, with no anaerobic bacteria. Histological examination revealed pyometra with necrosis of the endometrium and no evidence of malignancy. The patient was discharged on postoperative day 68 without any major complications. Pyometra is an unusual cause of peritonitis, but it must be considered as a possible diagnosis in elderly women presenting with an acute abdomen. Following this case report, we discuss the problems associated with establishing a correct preoperative diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra.

Computed tomography features of spontaneously perforated pyometra: a case report

“…Spontaneous perforation of a pyometra is an extremely rare complication. Only 16 cases have been reported so far and only one diagnosed preoperatively (5), which indicates the difficulty in giving a correct preoperative diagnosis of this disease. We report an elderly woman with generalized peritonitis and septic shock caused by spontaneous perforation of a pyometra diagnosed preoperatively during a computed tomography (CT) study.…”

Spontaneous Perforation of Pyometra: A Report of Seven Cases and Review of the Literature

“…The incidence of association with malignancy is reported to be 22-35% [7,20,24,27,38,39]. Since pyometra is caused by an impairment of the natural drainage of the cervix, it is likely to be associated with cervical, endometrial, or rectal or sigmoid colon cancer [7,20,24,27,38,39]. A pelvic examination should be performed to rule out associated malignancy.…”

“…Furthermore, as many patients with pyometra are asymptomatic [5], the diagnosis of pyometra is difficult. However, once pyometra perforation occurs, the pus spreads in the peritoneal cavity resulting in generalized peritonitis [24]. …”

“…We collected data from 47 patients diagnosed with spontaneous rupture of pyometra between 1949 and 2011 [2,3,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]. The available literature was carefully reviewed, and our patients' descriptions were included to evaluate the characteristics related to outcomes in cases of spontaneous rupture of pyometra.…”

Spontaneous uterine perforation due to pyometra presenting as acute abdomen

“…In early reports on pyometra, most of the cases where caused by cervical occlusion due to malignant lesions [1]. However, recent reports have shown that the condition can also have benign causes [2]. Only approximately 22 cases have been reported in the English literature so far [3].…”