Spontaneous uterine perforation due to pyometra presenting as acute abdomen

Nuamah, Nabil M; Hamaloğlu, Erhan; Konan, Ali

doi:10.1016/j.ijgo.2005.09.027

Cited by 36 publications

(27 citation statements)

References 2 publications

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“…[6][7][8][9] Malignant disease is present in 35% of cases. [6][7][8][9] Only in 10% of cases patients present gynaecological symptoms of altered uterine drainage before pyometra perforation. 4,10 When perforation occurs patients report acute abdominal pain, vomiting, and fever.…”

Section: Discussionmentioning

confidence: 99%

Perforated pyometra is a misleading cause of acute abdomen in elderly women: case report and review of literature

et al. 2017

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Even if acute abdomen is associated with gastrointestinal (GI) perforation in more than 90% of cases, spontaneously perforated pyometra is a rare and misleading cause that gynecologists and general surgeons should suspect in elderly postmenopausal women. We report one case of diffuse peritonitis caused by spontaneous uterine perforation. A 94-year-old postmenopausal female was admitted to emergency department with signs of diffuse peritonitis and seven days history of abdominal pain. Abdominal contrast-enhanced CT-scan showed a large amount of ascites and a small amount of intraperitoneal free-air. One hour after the admission septic shock developed and emergency laparotomy was performed for suspected GI perforation. During laparotomy about 1500 mL of purulent, malodorous but not-fecaloid fluid was found in peritoneal cavity, without evidence of GI perforation. A 10 mm perforation on the anterior part of the uterine fundus was found. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Patients died on postoperative day four despite intensive care for multi-organ failure due to septic shock. The hysto-pathology examination showed absence of cancer. Pyometra perforation is a rare cause of acute abdomen with a not negligible mortality and it should be considered in the differential diagnosis of acute abdomen, especially in elderly patients. The aim of the study is to report our personal experience and a review of the literature of spontaneous perforation of pyometra in patients with no evidence of malignancy.

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Section: Discussionmentioning

confidence: 99%

Perforated pyometra is a misleading cause of acute abdomen in elderly women: case report and review of literature

et al. 2017

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“…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.…”

Section: Methodsmentioning

confidence: 99%

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

Ikeda

Takahashi

Kurachi

2013

Gynecol Obstet Invest

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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.

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“…However, a significant percentage of patients with unruptured pyometra are asymptomatic (10). Additionally, due to the nonspecific symptoms associated with rupture, early and accurate diagnosis of perforation is limited.…”

Section: Case Presentationmentioning

confidence: 99%

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

et al. 2018

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Pyometra, the accumulation of purulent material in the uterine cavity, is a rare gynecological condition whose etiology is impaired drainage of the uterine cavity. It is uncommon in premenopausal age and occurs mainly in older and postmenopausal women. Clinical signs of pyometra are vaginal discharge, postmenopausal bleeding, and lower abdominal pain. An 87-year-old woman was admitted to our emergency department with abdominal pain, fever, and vomiting. The results of physical examination revealed rebound tenderness and muscular rigidity in the lower abdomen. Ultrasonography demonstrated free fluid in the abdomen, and percutaneous aspiration revealed that this fluid was purulent. A computed tomography scan showed a large amount of free fluid in the abdominal cavity and a uterine myoma. The patient underwent emergency laparotomy due to acute abdomen. During the laparotomy, a 2x1 cm perforation was seen at the fundus of the uterus. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. A culture of the pus grew Escherichia coli. Histopathological examination revealed degenerative uterine myoma with no evidence of malignancy. Pathological results indicated myometrial suppurative inflammation along with neutrophilia and necrosis. Pyometra is a rare event; however, it must be considered when investigating acute abdomen etiology. Because pyometra involves abscess formation, drainage and evacuation of the uterine cavity while leaving a drain in the cavity and dilating the cervical canal is the main treatment protocol. In cases of perforation, hysterectomy is the treatment choice; however, with concomitant diseases in older patients, immediate surgery is related to important morbidity and mortality risks.

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Spontaneous uterine perforation due to pyometra presenting as acute abdomen

Cited by 36 publications

References 2 publications

Perforated pyometra is a misleading cause of acute abdomen in elderly women: case report and review of literature

Perforated pyometra is a misleading cause of acute abdomen in elderly women: case report and review of literature

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

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

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