Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: Report of a case

Nakao, Atsunori; Mimura, Hisashi; Fujisawa, Kenji; Ezawa, Kazuhiko; Okamoto, Tomoko; Ishibashi, Hiromi; Isozaki, Hiroshi; Takakura, Norihisa; Tanaka, Noriaki

doi:10.1007/s005950050624

Cited by 34 publications

(22 citation statements)

References 9 publications

(10 reference statements)

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“…Furthermore, spontaneous rupture of pyometra in cervical cancer presenting as generalized peritonitis is extremely rare and only 4 cases have been reported [7]. The most common presenting symptoms and sign are abdominal pain, vomiting, nausea, fever and enlargement of the uterus [8]. The most common perforation site is the uterine fundus.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous uterine perforation of pyometra presented as an acute abdomen: A case report

Jeon

Shin

Kim

et al. 2012

Korean J Obstet Gynecol

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Pyometra is an uncommon condition in general population and caused by impairment of natural drainage of the cervix as a result of benign or malignant diseases. Spontaneous uterine perforation, a very rare complication of pyometra, carries signifi cant morbidity and mortality and should be considered in the differential diagnosis of other peritonitis. Preoperative diagnosis of perforated pyometra is diffi cult due to old age, poor general condition, and symptoms that present as abdominal pain related to gastrointestinal diseases. If a diagnosis of perforated pyometra is delayed, then it will be associated with increased morbidity and mortality. In the causes of uterine perforation, pyometra should be considered because of requiring proper intervention. A diagnosis of spontaneous perforated pyometra should always be kept as a possibility in all cases of abdominal pains associated with peritonitis in elderly women.

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Section: Discussionmentioning

confidence: 99%

Spontaneous uterine perforation of pyometra presented as an acute abdomen: A case report

Jeon

Shin

Kim

et al. 2012

Korean J Obstet Gynecol

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“…[4] In conclusion the diagnosis of spontaneous perforation of pyometra is rarely made preoperatively and the possibility of a perforated pyometra should therefore be considered when elderly women suffer from acute abdominal pain. Their management often difficult and hysterectomy and bilateral salpingo-oopherectomy may be the best choice procedure in these patients [5].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Uterine Perforation Due to Pyometra Presenting as Acute Abdomen

Sahoo¹,

Dora

Harika

et al. 2011

Indian J Surg

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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.

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“…In Case 1, an elderly woman with acute abdominal pain had PP caused by perforated pyometra. Only 18 cases of a spontaneous perforation of pyometra have been reported to date in the English literature, and PP was recognized in only 56% of the cases [8]. PP and multiple air pockets in the uterus were noted on a CT scan in Case 1.…”

Section: Discussionmentioning

confidence: 99%

“…However, intra-abdominal causes of PP associated with peritonitis other than ruptured GI tract are uncommon. To the best of our knowledge, ruptured hepatic abscess [2, 3], emphysematous cholecystitis [4], spontaneous bacterial peritonitis [5], and perforated pyometra in women [6, 7, 8]have been described as extremely rare causes of PP. In Case 1, an elderly woman with acute abdominal pain had PP caused by perforated pyometra.…”

Section: Discussionmentioning

confidence: 99%

Pneumoperitoneum without Perforation of the Gastrointestinal Tract

Omori

Asahi²,

Inoué³

et al. 2003

Dig Surg

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Pneumoperitoneum (PP) is usually the result of perforation of the gastrointestinal (GI) tract with associated peritonitis. However, other rare causes, including spontaneous PP incidental to intrathoracic, intra-abdominal, gynecologic, and miscellaneous other origins not associated with a perforated GI tract have been described in the literature. Six cases of PP without any perforated GI tract are reported. Three patients with generalized peritonitis underwent exploratory laparotomy or laparoscopy when clinical examinations suggested an acute abdomen. At surgical procedure, perforated pyometra, perforated liver abscess and a ruptured necrotic lesion of a liver metastasis were documented in these patients, respectively. We also saw 3 PP patients not associated with peritonitis. Two patients with PP caused by pneumatosis cystoides intestinalis were encountered, 1 was managed conservatively and the other received diagnostic laparoscopy. A patient in whom pneumomediastinum and pneumoretroperitoneum were accompanied by PP caused by an alveolar rupture based on decreased pulmonary compliance due to malnutrition was managed conservatively. The history of the patient and knowledge of the less frequent causes of PP can possibly contribute towards refraining from exploratory laparotomy in the absence of peritonitis.

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Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: Report of a case

Cited by 34 publications

References 9 publications

Spontaneous uterine perforation of pyometra presented as an acute abdomen: A case report

Spontaneous uterine perforation of pyometra presented as an acute abdomen: A case report

Spontaneous Uterine Perforation Due to Pyometra Presenting as Acute Abdomen

Pneumoperitoneum without Perforation of the Gastrointestinal Tract

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