ACUTE ABDOMEN DUE TO PERFORATION OF PYOMETRIA

Abstract

Case 1: A 77-year-old woman had a lower abdominal pain since January 12 1989. Muscular defense in the entire abdomen and genital bleeding were confirmed. With vaginal and plevic examinations the patient was diagnosed as having a cancer in the uterine cervix in stage 2b. Laparotomy was performed for acute generalized peritonitis, and the anterior wall of the uterine body perforating in the size of rice and outflow of pus were observed. It was diagnosed as perforation of pyometria due to the cancer in the uterine cerivix. Simple hysterectomy and bilateral adnexectomy were carried out. Case 2: An 86-year-old woman suddenly had an upper abdominal pain on September 5 1993. Simple abdominal X-ray film revealed intestinal air centered on the pelvic cavity, but there was no free air. On the next day muscular defense appeared in the lower abdomen. abdominal enhanced CT revealed heterogenous low density area in the uterine and collection of fluid surrounding it.Under a diagnosis of acute generalized peritonitis laparotomy was carried out. It was found that the anterior wall of the uterine body perforated in the size of pin hole and pus flowed out. The diagnosis of perforation of pyometria was made, simple hysterectomy being performed. No free air was seen in the both cases. Enhanced CT visualized a heterogenous low density area in the uterine. This imaging method can given an important clue to diagnose this disease.