Postmenopausal spontaneous uterine perforation: Case report

Abstract

Spontaneous uterine rupture and generalized peritonitis caused by pyometra occurs rarely with high morbidity and mortality. A correct and definite diagnosis can be made with laparotomy or laparoscopy. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and gynecologic symptoms are less frequent, which makes preoperative diagnosis difficult. We report a case of a patient aged 82 years who underwent surgery for spontaneous uterine rupture and generalized peritonitis as a result of pyometra.

Pneumoperitoneum Due to Spontaneous Uterine Perforation Caused by Pyometra – A Rare Finding and a Diagnostic Challenge

“…Malignant disease is present in 35% of cases. [7] In our patient there was no evidence of malignancy during surgery, she had no intrauterine device and had not undergone endometrial biopsy or dilatation curettage operations before. Therefore, the most probable cause of pyometra was postmenopausal changes and stenosis of the cervix causing stagnation of discharge resulting in anaerobic infection causing perforation at fundus and anterior uterine wall.…”

“…Pyometra, although rare in the general population, is found more frequently in postmenopausal women as a result of occlusion of the cervical canal by malignant or benign tumors, surgery, radiotherapy, and senile cervicitis. [7,8] The classical triad includes suprapubic pain, postmenopausal vaginal bleeding, and vaginal pus discharge, and. [7,9] However, more than 50% of all cases are asymptomatic.…”

“…[7,8] The classical triad includes suprapubic pain, postmenopausal vaginal bleeding, and vaginal pus discharge, and. [7,9] However, more than 50% of all cases are asymptomatic. [7,10,11] Although atrophic endometrium is a common cause, perforation is usually seen in the presence of serious causes such as cervical or endometrium carcinoma or a forgotten intrauterine device.…”

“…[7,9] However, more than 50% of all cases are asymptomatic. [7,10,11] Although atrophic endometrium is a common cause, perforation is usually seen in the presence of serious causes such as cervical or endometrium carcinoma or a forgotten intrauterine device. Malignant disease is present in 35% of cases.…”

Uterine Perforation in Postmenopausal Woman – Case Report

“…In cases of uterine perforation caused by pyometra the mortality rate stands at about 15%. In majority the cause of death is sepsis resulting in multiple organ failure [9] Uterine rupture resulting from pyometra is associated with high morbidity and mortality [13] The women present with no gynaecologic symptoms and confusing abdominal signs, which makes diagnosis difficult prior to surgery [14]…”