Spontaneous Uterine Perforation Due to Pyometra Presenting as Acute Abdomen

Abstract

Spontaneous perforation of uterus is rare, its incidence being about 0.01%-0.5%. We report a rare case of diffuse peritonitis and pneumoperitoneum caused by spontaneously perforated pyometra. A 50-year postmenopausal lady with abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy about 1,500 ml of pus present in peritoneal cavity and whole of alimentary tract and gallbladder were normal.A total abdominal hysterectomy with bilateral salpingooopherectomy was performed. Histopathological study revealed chronic suppurative endometritis with myometritis of the uterus with no evidence of malignancy. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore be considered when elderly female presents with acute abdomen.

Spontaneous perforation of pyometra: A rare cause of diffuse peritonitis

“…In most cases reported earlier, spontaneously perforated pyometra is a diagnosis made intra-operatively when the original clinical diagnosis had been gastrointestinal perforation. 1,3,4,6 The treatment of ruptured pyometra is immediate laparotomy, peritoneal lavage, drainage, and simple hysterectomy as was done in our case. Prognosis in cases of perforated pyometra is variable.…”

“…2,5,7 However, spontaneous perforation of pyometra presenting primarily as diffuse peritonitis, as in our case, is even more unusual. 3,7 Generalised pain abdomen with associated tenderness and guarding are clinical features of peritonitis. There was no pneumoperitoneum noticed in plain abdominal X-ray examination.…”

Perforación uterina espontánea por piometra secundaria a estenosis cervical

“…Esta estenosis puede ser secundaria a la realización de biopsias a dicho nivel, a la presencia de tumor o a su tratamiento, siendo una complicación esperable a partir de los 3-6 meses posradioterapia 4,5,8 . La perforación uterina espontánea secundaria a piometra es una entidad escasamente descrita en la literatura radiológica.…”

“…procedimiento ginecológico previo [2][3][4][5] . Los datos publicados sobre las causas de esta entidad son variados.…”

“…En un estudio retrospectivo realizado por Chang et al, el 74% de los casos eran idiopáticos, mientras que el piometra se asociaba en un 22,2% de los casos a tumores malignos 6 . Otras publicaciones describen que el piometra se presentaría más frecuentemente en mujeres posmenopáusicas con estenosis del canal cervical, en muchos casos secundaria a patologías malignas tratadas con radioterapia [3][4][5] . Así, Babarinsa et al encontraron una asociación del 0,89% entre el piometra y el cáncer de cérvix 7 .…”