A CASE OF PERFORATED PYOMETRA ASSOCIATED WITH DIFFUSE PERITONITIS

Abstract

A case of perforated pyometra associating with diffuse peritonitis is reported. An 88-year-old woman was referred to the hospital by a phisician because of a suspicion of acute appendicitis. Simple abdominal X-ray film revealed no free air. Abdominal enhanced CT revealed collection of fluid in the Douglas' pouch and uterine. White blood cell count increased and CRP level was high. The patient was diagnosed as having diffuse peritonitis caused by intestinal perforation and immediately operated on. On lapalotomy, it ws found that the anterior wall of the uterine body perforated and pus flowed out from the site. With a diagnosis of perforated pyometra associated with diffuse peritonitis, histerectomy and bilateral salphingoophorectomy with abdominal drainage were performed. Postoperative course was uneventful. Histological examination of the surgical specimen revealed no findings of malignancy. In a case of acute abdomen in aged woman, this disease should be considered and appropriate examination would permit to make the diagnosis of the disease preoperatively.