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

Abstract

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.

Diffuse peritonitis caused by spontaneous perforation of pyometra: A case report and literature review

“…If they are not treated in time, septic shock and multiple organ dysfunction may occur, and the original disease may even be life-threatening. According to the literature, the median age of rupture and perforation of empyema is 73.8 years; for elderly women with complicated diseases, the mortality rate is 25-40% [1,6,7,9]. The principle of treatment of this disease is to carry out blood, body uid or faecal bacterial culture and drug sensitivity tests on the basis of symptomatic and supportive therapy.…”

“…Genital infection in elderly women is a common gynaecological disease, but the resulting empyema is less common; uterine perforation caused by empyema is even rarer, and its complications often conceal the symptoms of the original disease and lead to misdiagnosis [1]. Here, we report a patient who presented with abdominal pain and diffuse peritonitis due to empyema and perforation.…”

“…Authors' information 1 The Second Department of General Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, China 2 The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu Province, China…”

Idiopathic pyometra and tubo-ovarian abscess in a postmenopausal patient treated conservatively

“…Several causes could lead to pyometra, such as a cervical or an endometrial malignancy, prior pelvic radiation and, in addition, benign conditions, specifically leiomyomas, endometrial polyps, congenital anomalies, occlusion of the cervix after surgery and retention of an IUD (intrauterine device) [ 2 ], or it could be idiopathic [ 3 ]. Pyometra manifests with lower abdominal pain, postmenopausal bleeding and vaginal discharge [ 4 ]. It is a consequence of a blocked cervical canal [ 5 ].…”

Damage control surgery for spontaneous perforation of pyometra with septic shock: a case report

“…Spontaneous perforation of pyometra is a very rare condition, which sometimes causes severe sepsis and septic shock, leading to lethal conditions 1,2 . Although damage control surgery (DCS) reportedly improves the survival of critically ill patients, 3 there has been no report describing DCS for ruptured pyometra.…”