Rare cause of acute surgical abdomen with free intraperitoneal air: Spontaneous perforated pyometra. A report of 2 cases

Lim, Siew Fung; Lee, Song Liang; Chiow, Adrian Kah Heng; Foo, Chek Siang; Wong, Andrew Siang Yih; Tan, Shici

doi:10.12659/ajcr.882629

Cited by 12 publications

(5 citation statements)

References 19 publications

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“…Fig. 1 lists the imaging characteristics of the 22 uterine rupture cases [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. All of these patients except one were menopausal women, with a median age of 70, ranging from 40 to 90 years.…”

Section: Resultsmentioning

confidence: 99%

Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study

He¹,

Li²,

Long³

et al. 2021

Clinical and Experimental Obstetrics & Gynecology

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Background: Spontaneous perforation of pyometra is a rare clinical emergency with high mortality. As pyometra perforation is difficult to recognize pre-operatively, many cases are mis-diagnosed as gastrointestinal (GI) rupture. This study aimed to develop a strategy to improve diagnostic accuracy of spontaneous uterine perforation in female patients with acute abdomen. Methods: Twenty-two women with spontaneous rupture of the uterus (twenty cases previously reported in the literature plus two cases from the authors' hospital) were included in the study group, another 22 menopausal patients with GI perforation were selected as the control group. Radiologists carefully reviewed the CT images and reports and summarized some common signs in patients with spontaneous perforation of pyometra. GI patients' CT images were also scrutinized for these characteristic signs. The occurrence of these features was calculated in both groups. All patients underwent abdominal surgical exploration and most of patients diagnosed with spontaneous perforation of pyometra received hysterectomy and bilateral oophorectomy. Results: Five characteristics were specifically detected in patients with uterine spontaneous perforation: (1) Fluid collected in the cul-de-sac, incidence 95.5%; (2) Fluid in the uterine cavity, incidence 100%; (3) Intrauterine free air, incidence 90.9%; (4) Free air around the uterus, incidence 77.2%; (5) Defects on the uterine wall, incidence 72.7%. However, these five signs were rarely observed in control patients with GI perforation. A dignostic strategy combined clinical findings with raidiological features were developed to help identify these patients. Conclusions:The above five CT characteristics and the developed dignostic algorithm could be used as a tool to facilitate the preoperative diagnosis of spontaneous perforation of pyometra, although more tests are needed in large samples of cases.

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Section: Resultsmentioning

confidence: 99%

Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study

He¹,

Li²,

Long³

et al. 2021

Clinical and Experimental Obstetrics & Gynecology

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show abstract

“…Cervical dilatation and drainage, on the other hand, must be addressed in unruptured instances of pyometra. In instances when fertility should be preserved, abdominal cavity irrigation following uterine cavity evacuation and uterine perforation repair should be considered [34,35].…”

Section: Uterine Perforation Caused By Pyometramentioning

confidence: 99%

Causes and Management of Uterine Perforation- A Review

Bishrah

Abbas

Almalki

et al. 2021

JPRI

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Uterine perforation is an intrauterine problem that can occur with any therapy. It is a rare but possibly dangerous consequence of uterine manipulation, evacuation of retained products of conception or pregnancy termination (TOP), hysteroscopic treatments, and coil implantation. Injury to blood arteries or viscera, such as the bladder or the intestine, might be related. Severe bleeding or infection may ensue if not discovered at the time of surgery; nevertheless, the most majority of uterine drilling is subclinical and safe without treatment, with no substantial long-term damage. Perforation can be caused by cervical stenosis during trans-cervical operations or by a reduction in myometrial wall strength during pregnancy or menopause. Uterine abnormalities, infection, recent pregnancy, and postmenopause are all factors that raise the chance of uterine perforation. The treatment of uterine perforation is determined by the operation and the equipment employed. Admission to the hospital, intravenous antibiotics, and close supervision are required following a uterine perforation and any accompanying injuries. In this paper, we overview common causes and updated management of uterine perforation. Data was collected during a period of 6 months searching Pubmed, EPISCO, Web of science data bases to include studies with relative topics.

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“…Pyometra is related to a general etiology of benign or malignant gynecologic tumors, radiation cervicitis, atrophic cervicitis, congenital anomalies, intrauterine devices, and traumatic damage to the cervix (7). If the pyometra is related to malignancy and perforation of the uterus, the prognosis is very poor and bears significant morbidity and mortality risks (8).…”

Section: Case Presentationmentioning

confidence: 99%

“…Pyometra involves abscess formation; drainage and evacuation of the uterine cavity is the main treatment protocol, along with placing a drain in the cavity and dilating the cervical canal (8,15). Persistent pyometra requires repeated drainage and dilatation.…”

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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Rare cause of acute surgical abdomen with free intraperitoneal air: Spontaneous perforated pyometra. A report of 2 cases

Cited by 12 publications

References 19 publications

Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study

Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study

Causes and Management of Uterine Perforation- A Review

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

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