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

Abstract

Background/Aims: The spontaneous perforation of pyometra is very rare and is associated with a poor prognosis. The present study aimed to evaluate the clinical characteristics and prognostic factors for patient survival. Patients and Methods: We reported on 7 patients with spontaneous rupture of pyometra. We also reviewed 47 additional published cases. Thus, all 54 patients were analyzed for mortality. Results: We investigated the prognosis in 44 of 54 patients, excluding 8 patients with undocumented outcome and 2 who died of other diseases. The mortality rate was 25% (11 of 44). In univariate analysis, variables such as age, correct preoperative diagnosis, comorbidities, the presence of malignancy, and hysterectomy were not significant between surviving and deceased patients. In bacterial cultures from the peritoneal cavity, the most common etiological organisms were Escherichia coli and anaerobes such as Bacteroides and Peptococcus species. The rate of isolation of anaerobic bacteria was significantly increased in patients who died (odds ratio, 6.33; 95% confidence interval, 1.28-31.02; p = 0.04). Conclusion: Antibiotic therapy for E. coli and anaerobes should be considered in patients with spontaneous perforation of pyometra.

Spontaneous perforation of pyometra: A rare cause of acute abdomen and sepsis

“…In the literature, the median age of ruptured pyometra was 73.8; in geriatric women with concomitant diseases, the mortality rate is 25% to 40% (5,6,9). For these septic geriatric patients, emergency conditions and surgery require resuscitation and management of respiration as well as circulation in the intensive care unit and long hospital stays, as in the case of the patient reported in this study.…”

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

“…This condition, including cervical stenosis, is commonly caused by benign or malignant gynecologic tumors, atrophic cervicitis with aging, puerperal infection, radiation cervicitis, longterm use of an intrauterine device, or congenital uterine anomalies 5,6,8) . In general, the most common microorganisms causing pyometra are E. coli, Streptococcus spp., Bacteroides fragilis, and Peptostreptococcus anaerobius 7,9) . The main symptoms of pyometra are lower abdominal pain, purulent vaginal discharge, and postmenopausal bleeding, although more than 50% of patients are asymptomatic.…”

Spontaneous Rupture of Pyometra in a Nonpregnant Young Woman

“…Intensive antibiotic therapy is considered important for a favorable outcome because these patients easily develop generalized peritonitis followed by septic shock [20]. …”