Spontaneous Perforated Pyometra Presenting as Pneumoperitoneum

Ikematsu, Yoshito; Kitajima, Tomoo; Kamohara, Yukio; Inoue, Keiji; Maeda, Junpei; Amano, Minoru; Kohzaki, Shuichi

doi:10.1159/000291980

Cited by 16 publications

(8 citation statements)

References 6 publications

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“…Possible etiologies are many and include benign or malignant gynecologic neoplasms, cervical stenosis, atrophic cervicitis, senile cervicitis, gynecology related postoperative complications, postradiation therapy, congenital malformations (anomalies), uterine infections, age-related endometritis, puerperal endometritis with retention of lochia, use of intrauterine device (IUD), and others [1, 5, 6]. The incidence of concomitant gynecologic malignancy as an underlying etiology for pyometra is considerably high [4], particularly in elderly postmenopausal women [7]. …”

Section: Discussionmentioning

confidence: 99%

Generalized Peritonitis Secondary to Spontaneous Perforation of Pyometra in a 63-Year-Old Patient

Abu‐Zaid

Alomar

Nazer

et al. 2013

Case Reports in Obstetrics and Gynecology

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Spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. Herein, we report the case of a 63-year-old woman who presented to emergency department with a 2-day history of severe diffuse abdominal pain, high-grade fever, nausea, and vomiting. Acute abdomen series was done, and upright plain chest radiograph showed free air under diaphragm. A noncontrast-enhanced computed tomography scan showed a significantly distended fluid-filled uterus measuring 10 × 7.8 × 10 cm, in addition to a single focus of perforation involving the uterine fundus and associated with presence of free air within the nondependant area. No evidence of ascites or pelvi-abdominal lymphadenopathy was identified. A preoperative diagnosis of generalized peritonitis secondary to spontaneous perforation of uterus was established. Subsequently, patient underwent urgent exploratory laparotomy which revealed pus-filled uterus with perforated fundus. Diagnosis of generalized peritonitis secondary to spontaneous perforation of pyometra was established. Consequently, patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, as well as thorough drainage and irrigation of pelvi-abdominal cavity. Postoperatively, patient was admitted to intensive care unit. Histopathological examination of uterus was negative for malignancy, and surgical culture grew Streptococcus constellatus. Patient had an uneventful recovery. Moreover, a brief literature review on pyometra is presented.

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Section: Discussionmentioning

confidence: 99%

Generalized Peritonitis Secondary to Spontaneous Perforation of Pyometra in a 63-Year-Old Patient

Abu‐Zaid

Alomar

Nazer

et al. 2013

Case Reports in Obstetrics and Gynecology

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“…Podría presentarse también con aire en el interior de la cavidad uterina o el neumoperitoneo 1,9,10 . El papel de la ecografía en el diagnóstico de la rotura uterina es limitado debido a la dificultad para ver el desgarro uterino y una mala ventana acústica secundaria a la perforación 9 .…”

Section: Discussionunclassified

Perforación uterina espontánea por piometra secundaria a estenosis cervical

Baleato-González

Rodríguez

García‐Figueiras

2014

Progresos de Obstetricia y Ginecología

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Recibido el 28 de enero de 2014; aceptado el 5 de agosto de 2014 Disponible en Internet el 18 de septiembre de 2014 PALABRAS CLAVE Perforación; Útero; Piometra; Estenosis; CérvixResumen Se presenta un caso de perforación uterina espontánea secundaria a piometra. La perforación uterina es una rara entidad que afecta principalmente a mujeres posmenopáusicas debido a la retención de las secreciones de la cavidad uterina por obstrucción del canal cervical. Su presentación clínica es inespecífica, con dolor abdominal bajo, fiebre, vómitos y datos analíticos de infección, y sus complicaciones potencialmente graves, como peritonitis o shock séptico, de ahí la importancia de su diagnóstico precoz mediante técnicas de imagen. ß 2014 SEGO. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.Spontaneous uterine perforation due to pyometra secondary to cervical stenosis Abstract This paper reports a case of spontaneous perforation due to pyometra. Spontaneous uterine perforation is a rare event that usually affects postmenopausal women. It is secondary to retention of purulent secretions in the uterine cavity caused by obstruction of the cervical canal. The diagnosis is difficult to establish because the clinical presentation is nonspecific and includes abdominal pain, fever, vomiting and laboratory data indicating infection. An early imaging diagnosis is mandatory due to the potentially severe complications of this event such as peritonitis and septic shock. ß 2014 SEGO. Published by Elsevier España, S.L.U. All rights reserved. IntroducciónEl piometra es una patología infrecuente caracterizada por la presencia de material purulento dentro de la cavidad uterina secundaria a la retención de las secreciones por obstrucción del canal cervical. Su incidencia varía entre 0,01 y 0,05% 1-3 , aumentando a un 0,2-1,5% en pacientes sometidas a algún

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“…We collected data from 47 patients diagnosed with spontaneous rupture of pyometra between 1949 and 2011 [2,3,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]. The available literature was carefully reviewed, and our patients' descriptions were included to evaluate the characteristics related to outcomes in cases of spontaneous rupture of pyometra.…”

Section: Methodsmentioning

confidence: 99%

Spontaneous Perforation of Pyometra: A Report of Seven Cases and Review of the Literature

Ikeda

Takahashi

Kurachi

2013

Gynecol Obstet Invest

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Background/Aims: The spontaneous perforation of pyometra is very rare and is associated with a poor prognosis. The present study aimed to evaluate the clinical characteristics and prognostic factors for patient survival. Patients and Methods: We reported on 7 patients with spontaneous rupture of pyometra. We also reviewed 47 additional published cases. Thus, all 54 patients were analyzed for mortality. Results: We investigated the prognosis in 44 of 54 patients, excluding 8 patients with undocumented outcome and 2 who died of other diseases. The mortality rate was 25% (11 of 44). In univariate analysis, variables such as age, correct preoperative diagnosis, comorbidities, the presence of malignancy, and hysterectomy were not significant between surviving and deceased patients. In bacterial cultures from the peritoneal cavity, the most common etiological organisms were Escherichia coli and anaerobes such as Bacteroides and Peptococcus species. The rate of isolation of anaerobic bacteria was significantly increased in patients who died (odds ratio, 6.33; 95% confidence interval, 1.28-31.02; p = 0.04). Conclusion: Antibiotic therapy for E. coli and anaerobes should be considered in patients with spontaneous perforation of pyometra.

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Spontaneous Perforated Pyometra Presenting as Pneumoperitoneum

Cited by 16 publications

References 6 publications

Generalized Peritonitis Secondary to Spontaneous Perforation of Pyometra in a 63-Year-Old Patient

Generalized Peritonitis Secondary to Spontaneous Perforation of Pyometra in a 63-Year-Old Patient

Perforación uterina espontánea por piometra secundaria a estenosis cervical

Spontaneous Perforation of Pyometra: A Report of Seven Cases and Review of the Literature

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