Perforated pyometra presenting as a pelvic abscess: A case report

Abstract

Introduction: Pyometra ­ the accumulation of purulent material inside the uterus – can be asymptomatic in 50% of cases. A perforated pyometra usually presents with an acute abdomen at the outset and it is unusual for it to present as a pelvic abscess. Case Report: We present the case of a 57­years­old lady, who presented with increasing epigastric pain. She was hypotensive with epigastric tenderness. She had an elevated white count and elevated liver enzymes. Imaging did not reveal the etiology of her condition. She started to have peritoneal signs on hospital day nine and was taken to the operating theatre for exploratory laparotomy. A pelvic abscess was found that was communicating with a perforated pyometra. Hysterectomy and bilateral salpingo­ oophorectomy was performed. No evidence of malignancy was found on histo pathologic examination. The patient had post operative ileus and was on parenteral nutrition. She soon recovered and was discharged home. Conclusion: A perforated pyometra is usually seen in post menopausal women and presents as an acute abdomen. It is associated with blockage of the endocervical canal. The patient in this case had a pelvic abscess that had walled off the perforation. The patient had symptoms for a while as overt peritonitis had not developed. No malignancy was identified. A high index of suspicion is needed to diagnose a perforated pyometra in postmenopausal patients presenting as an acute abdomen or a pelvic abscess. It may not be associated with malignancy and presentation may be overtly acute or insidious.