Background: An uncommon condition known as pyometra occurs when natural drainage of the uterine cavity is compromised and pus accumulates within the cavity. The reported incidence is 0.1%–0.5% in gynecologic patients and is much higher in elderly women. Spontaneous perforation of pyometra and subsequent diffuse peritonitis is very rare. Case: A postmenopausal (age 60, para 3) woman presented in an emergency department with fever and pain in her abdomen. Features of generalized peritonitis were present on examination. Laparotomy was performed, and a rent with pus leaking from it was found on the anterior wall of the uterus. Subtotal hysterectomy with bilateral salpingo-oophorectomy with cervical cytology was performed. Results: There was no evidence of malignancy on histopathology and cytology examination. Pyometra was caused by senile endometritis, and pus was not expelled out because of cervical stenosis. This case had an unusual presentation in the form of a rupture of pyometra with subsequent development of peritonitis. Conclusions: Spontaneous uterine perforation caused by pyometra should be kept in mind as one of the differential diagnosis in a postmenopausal woman presenting with generalized peritonitis. Clinicians usually miss the diagnosis of rupture of pyometra in a previously asymptomatic elderly female; this report will help create the awareness to avoid this life-threatening condition. (J GYNECOL SURG 33:71)
Read full abstract