Spontaneous perforation of pyometra presenting as acute abdomen: a rare condition with considerable mortality

Yin, Wanbin; Wei, Yanhua; Liu, Guangwei; Zhao, Xiaotang; Zhang, Mao-Shen; Hu, Jilin; Zhang, Nan-Yang; Lu, Yun

doi:10.1016/j.ajem.2015.08.029

Cited by 10 publications

(9 citation statements)

References 10 publications

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“…However, not all patients with empyema have typical symptoms. When treating digestive system symptoms, it is easily misdiagnosed as a perforation of the digestive tract in clinical practice, especially in elderly patients [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Diffuse peritonitis caused by spontaneous perforation of pyometra: A case report and literature review

Xu¹,

Zhuang²,

Caiming³

et al. 2021

Preprint

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BackgroundUterine perforation is commonly caused by iatrogenic injuries, tumours, and traumas. Uterine perforation resulting from infection is less common, and such perforation rarely causes abdominal empyema and diffuse peritonitis. Infectious complications such as shock and multiple organ dysfunction are extremely dangerous and even life threatening. Correct early diagnosis and appropriate treatment can reduce the mortality of pyometra.Case presentationA 62-year-old woman presented to our hospital with persistent abdominal pain for 5 hours. The patient had undergone hysteroscopy six months ago, and a cystic space-occupying lesion of the uterus was found one month ago. Perfect the various examinations, consider the patient as acute diffuse peritonitis Perforation of the digestive tract? Uterine cavity infection. In the emergency department, laparoscopic exploration was performed. During the operation, it was diagnosed as pyometra and perforation of the right uterine fundus. Then, combined with a gynecologist, a hysterectomy with double appendages was performed. The operation went smoothly. The patient had paralytic intestinal obstruction after the operation. After active symptomatic treatment The patient recovered well and was discharged. Postoperative pathology results were as follows: 1. Moderately differentiated squamous cell carcinoma of the cervix (non-keratinizing type); 2. Metastatic squamous cell carcinoma of the right ovary; 3. Perforation of the fundus of the uterus, pyometra, and extensive purulent inflammation of the muscle wall .ConclusionsUterine perforation is a rare cause of acute abdomen. Clinicians often don't know enough about this, and they are prone to misdiagnosis and missed diagnosis. For elderly women with abdominal pain and peritonitis, the possibility of empyema perforation should be considered during diagnosis and treatment, and the examination should be improved to avoid misdiagnosis, because correct early diagnosis and appropriate treatment can reduce the mortality of empyema.

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Section: Discussionmentioning

confidence: 99%

Diffuse peritonitis caused by spontaneous perforation of pyometra: A case report and literature review

Xu¹,

Zhuang²,

Caiming³

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Typically, there is also exquisite tenderness to any slight uterine movement during the sonographic or physical examination. (9)(10)(11) On magnetic resonance imaging, the fluid within the endometrial cavity is hyperintense on T2weighted imaging and shows restricted diffusion; discontinuity of the uterine wall may also be evident. (12) Although the diagnosis is typically straightforward given the characteristic imaging appearances, particularly on CT, one radiological mimic to be aware of is necrosis of a uterine fibroid.…”

Section: Discussionmentioning

confidence: 99%

Clinics in diagnostic imaging (199)

Tay¹,

Subramanian²,

Chinchure³

et al. 2019

smedj

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M e d i c a l E d u c a t i o n CASE PRESENTATION A 92-year-old Chinese woman with a history of hypertension, diabetes mellitus and ischaemic heart disease presented to the emergency department with constipation, urinary incontinence and reduced oral intake of five days' duration. On examination, she was febrile (38.2 o C) with suprapubic tenderness. Renal punch was negative. Initial laboratory markers revealed leucocytosis of 27.2 × 10 9 /L (normal 4.0-9.6 × 10 9 /L), C-reactive protein of 252.3 mg/L (normal 0.0-5.0 mg/L), serum glucose level of 15.0 mmol/L (normal 0.0-11.1 mmol/L) and glycated haemoglobin of 8.7% (normal < 6.0%). Her urine and blood cultures were negative for bacteria, but urine phase-contrast microscopy revealed leucocytes in her urine. Computed tomography (CT) of her abdomen and pelvis was performed two days into her admission (Fig. 1), and a transvaginal ultrasonography (US) was performed a day later (Fig. 2). What do the images show? What is the diagnosis? CMEArticle

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“…Spontaneous perforation of pyometra is rare and may cause a generalised peritonitis, mimicking gastrointestinal origin 2 3. Despite adequate management, consisting of an emergency laparotomy, drainage of pus and sometimes a hysterectomy (reducing curative chances in case of malignancy), morbidity and mortality (>40%) rates are high 3…”

Section: Descriptionmentioning

confidence: 99%

Spontaneous perforation of pyometra presenting as acute abdomen: a rare condition with considerable mortality

Cited by 10 publications

References 10 publications

Diffuse peritonitis caused by spontaneous perforation of pyometra: A case report and literature review

Diffuse peritonitis caused by spontaneous perforation of pyometra: A case report and literature review

Clinics in diagnostic imaging (199)

Acute abdomen caused by spontaneous perforation of pyometra in a patient with cervical cancer

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