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

Atsunori Nakao, Hisashi Mimura, Kenji Fujisawa, Kazuhiko Ezawa, Takahiro Okamoto, Hiromi Iwagaki, Hiroshi Isozaki, Norihisa Takakura, Noriaki Tanaka

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24 Citations (Scopus)

Abstract

We report a rare case of generalized peritonitis due to a ruptured pyometra in an 86-year-old woman, and also conduct a review of the previous Japanese literature. The patient presented with muscle gnarding and rebound tenderness. Computed tomography (CT) disclosed a cystic mass in the peritoneal cavity, in which an air-fluid level was noted. Pneumoperitoneum around the uterus due to gas production of anaerobic bacteria was noted on a CT. At laparotomy, the uterus was markedly enlarged with a necrotic area on the uterine fundus, which was found to be perforated. A supravaginal hysterectomy and drainage were performed. We found only eight cases of a ruptured pyometra presenting as pneumoperitoneum in the Japanese literature between 1977 and 1999. The most common cause of pneumoperitoneum is a perforation of the gastrointestinal tract. However, other possible causes, as seen in our patient, should also be taken into consideration. Although it is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.

Original languageEnglish
Pages (from-to)454-457
Number of pages4
JournalSurgery today
Volume30
Issue number5
DOIs
Publication statusPublished - 2000

Keywords

  • Diffuse peritonitis
  • Elderly women
  • Pyometra
  • Rupture of uterus

ASJC Scopus subject areas

  • Surgery

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    Nakao, A., Mimura, H., Fujisawa, K., Ezawa, K., Okamoto, T., Iwagaki, H., Isozaki, H., Takakura, N., & Tanaka, N. (2000). Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: Report of a case. Surgery today, 30(5), 454-457. https://doi.org/10.1007/s005950050624