Pyometra, by definition, is a collection of purulent fluid within the uterine cavity. Incidence has been estimated to range from 0.1% to 0.5%. Typically, this is linked to postmenopausal women; however, it has been linked to premenopausal women with concordant use of intrauterine devices. Based on our knowledge, there have been less than 50 recorded cases reported in the English literature regarding perforation of pyometra resulting in acute abdomen and fewer than 25 resulting in pneumoperitoneum. We report a patient who was evaluated for diffuse peritonitis caused by perforated pyometra who was successfully treated with surgical intervention.
Neuroendocrine tumors (NETs) are rare tumors that are often asymptomatic and were once considered benign. A specific subtype that we will dive into in this article is appendiceal neuroendocrine tumors (ANETS). ANETs are the most common tumors located within the appendix. Most often, they present as acute appendicitis and are found incidentally on pathology reports status post appendectomy. The objective of this article is to show that even though most of the ANETs are benign and fully treated via surgery, ANETs still have the potential to become malignant and metastasize. Our patient fits the common features seen in ANETS. She is a middle-aged woman with vague abdominal pain and no clear diagnosis on gastrointestinal (GI) workup. Computed tomography (CT) confirmed appendicitis, and pathology reports status post-surgery confirmed stage IV, pT4, Nx, M1-poorly differentiated neuroendocrine carcinoma of the appendix with omental metastases.
Pneumatosis intestinalis can be identified radiographically incidentally in an asymptomatic patient, or it may be present in its fulminant form with peritonitis. Although multiple mechanisms have been postulated, most believe it arises from mechanical or infectious factors. Respiratory factors have also been described as possible causes for this condition. Clinically, it is important to differentiate among patients whom require surgical intervention from those who would benefit from conservative management, such as hyperbaric oxygen, changes in diet, and/or antibiotic administration. Although supplemental oxygen has become the standard of care for the treatment of benign pneumatosis intestinalis, we question whether all patients require oxygen therapy as a treatment. Although oxygen may be beneficial, the literature suggests there may be detrimental effects from oxygen toxicity and the free radicals formed during hyper-oxygenation. Furthermore, given the rising epidemic of antibiotic resistance and the various toxicities associated with usage of antibiotics, do all patients really require antibiotics? We present a case of a patient with complaints of hematuria, but no other gross abdominal complaints and was incidentally found to have pneumatosis intestinalis and pneumoperitoneum without any evidence of vascular compromise or ischemia. This patient was managed successfully with conservative treatment without oxygen therapy or antibiotics.
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