Korean J Obstet Gynecol.  2010 Apr;53(4):377-380. 10.5468/kjog.2010.53.4.377.

Spontaneous uterine perforation due to pyometra presenting as acute abdomen in older age

• Lee SM
• Jo YS
• Kim MJ
• Kim EJ
• Kim SJ

• KMID: 2273867
• DOI: http://doi.org/10.5468/kjog.2010.53.4.377

Abstract

Pyometra is an accumulation of purulent fluid in the uterine cavity. Generalized peritonitis secondary to a perforated pyometra is extremely rare. Most of the pyometra perforation is associated with malignancy. We have experienced a case of generalized peritonitis secondary to a perforated pyometra with no associated malignancy.

Keyword

Pyometra; Perforation

MeSH Terms

Abdomen, Acute
Peritonitis
Pyometra
Uterine Perforation

Figure

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  Fig. 1 Small air bubbles are seen on anterior body of uterus on CT scan.

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  Fig. 2 Notice a 1 cm sized hole on the anterior wall of the uterus.

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  Fig. 3 The resected uteus was filled with dark yellowish pus.

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  Fig. 4 Microscopic findings of pyometra. The microphotography reveals the endometrium infiltrated with numerous inflammatory cells (×200).

Reference

1. Whiteley PF, Hamlett JD. Pyometra: a reappraisal. Am J Obstet Gynecol. 1971. 109:108–112.

2. Ikematsu Y, Kitajima T, Kamohara Y, Inoue K, Maeda J, Amano M, et al. Spontaneous perforated pyometra presenting as pneumoperitoneum. Gynecol Obstet Invest. 1996. 42:274–276.

3. Hansen PT, Lindholt J. Spontaneously perforated pyometra: a differential diagnosis in acute abdomen. Ann Chir Gynaecol. 1985. 74:294–295.

4. Yildizhan B, Uyar E, Sişmanoğlu A, Güllüoğlu G, Kavak ZN. Spontaneous perforation of pyometra. Infect Dis Obstet Gynecol. 2006. 2006:26786.

5. Omori H, Asahi H, Inoue Y, Irinoda T, Saito K. Pneumoperitoneum without perforation of the gastrointestinal tract. Dig Surg. 2003. 20:334–338.

6. Nakao A, Mimura H, Fujisawa K, Ezawa K, Okamoto T, Iwagaki H, et al. Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: report of a case. Surg Today. 2000. 30:454–457.

7. Breckenridge JW, Kurtz AB, Ritchie WG, Macht EL Jr. Postmenopausal uterine fluid collection: indicator of carcinoma. AJR Am J Roentgenol. 1982. 139:529–534.

9. Chan LY, Yu VS, Ho LC, Lok YH, Hui SK. Spontaneous uterine perforation of pyometra: a report of three cases. J Reprod Med. 2000. 45:857–860.