Spontaneous Perforation Of Pyometra Research Articles

Spontaneous Perforation of Pyometra—What Literature Teaches Us?

Spontaneous Perforation of Pyometra—What Literature Teaches Us?

Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study

Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study

Spontaneous perforation of pyometra: A rare cause of acute abdomen and sepsis.

Pyometra, the accumulation of purulent material in the uterine cavity, is a rare gynecological condition whose etiology is impaired drainage of the uterine cavity. It is uncommon in premenopausal age and occurs mainly in older and postmenopausal women. Clinical signs of pyometra are vaginal discharge, postmenopausal bleeding, and lower abdominal pain. An 87-year-old woman was admitted to our emergency department with abdominal pain, fever, and vomiting. The results of physical examination revealed rebound tenderness and muscular rigidity in the lower abdomen. Ultrasonography demonstrated free fluid in the abdomen, and percutaneous aspiration revealed that this fluid was purulent. A computed tomography scan showed a large amount of free fluid in the abdominal cavity and a uterine myoma. The patient underwent emergency laparotomy due to acute abdomen. During the laparotomy, a 2×1 cm perforation was seen at the fundus of the uterus. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. A culture of the pus grew Escherichia coli. Histopathological examination revealed degenerative uterine myoma with no evidence of malignancy. Pathological results indicated myometrial suppurative inflammation along with neutrophilia and necrosis. Pyometra is a rare event; however, it must be considered when investigating acute abdomen etiology. Because pyometra involves abscess formation, drainage and evacuation of the uterine cavity while leaving a drain in the cavity and dilating the cervical canal is the main treatment protocol. In cases of perforation, hysterectomy is the treatment choice; however, with concomitant diseases in older patients, immediate surgery is related to important morbidity and mortality risks.

Acute Presentation of Pyometra in an Elderly Female

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)

Spontan pyometra perforasyonu; nadir bir akut karın sebebi: Olgu sunumu

Spontaneous perforation of pyometra; a rare cause of acute abdomen: report of a case Pyometra is defined as pooling of purulent material in the uterine cavity. We report a perforated pyometra presented with acute abdomen who was initially diagnosed as gastrointestinal perforation. A 68 year old woman was admitted as an emergency having developed sudden lower abdominal pain. Plain abdominal X-ray revealed free air in the peritoneal cavity. At laparotomy, enlarged perforated uterus of 12x7x4 cm in size was revealed. Hysterectomy and bilateral salpingooophorectomy was performed. Postoperative period was uneventful. Patient was discharged at thirteenth day. Although rare, perforation of pyometra should be considered in the differential diagnosis in an elderly woman with an acute abdomen.

Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin.

Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required.

Erratum to “Generalized Peritonitis Secondary to Spontaneous Perforation of Pyometra in a 63-Year-Old Patient”

The name of the senior author (Ismail Al-Badawi) was spelled incorrectly and is corrected here as Ismail A. Al-Badawi.

Spontaneous uterine perforation of pyometra presenting as acute abdomen.

Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts.

Spontaneous Perforation of Pyometra: A Report of Seven Cases and Review of the Literature

Background/Aims: The spontaneous perforation of pyometra is very rare and is associated with a poor prognosis. The present study aimed to evaluate the clinical characteristics and prognostic factors for patient survival. Patients and Methods: We reported on 7 patients with spontaneous rupture of pyometra. We also reviewed 47 additional published cases. Thus, all 54 patients were analyzed for mortality. Results: We investigated the prognosis in 44 of 54 patients, excluding 8 patients with undocumented outcome and 2 who died of other diseases. The mortality rate was 25% (11 of 44). In univariate analysis, variables such as age, correct preoperative diagnosis, comorbidities, the presence of malignancy, and hysterectomy were not significant between surviving and deceased patients. In bacterial cultures from the peritoneal cavity, the most common etiological organisms were Escherichia coli and anaerobes such as Bacteroides and Peptococcus species. The rate of isolation of anaerobic bacteria was significantly increased in patients who died (odds ratio, 6.33; 95% confidence interval, 1.28-31.02; p = 0.04). Conclusion: Antibiotic therapy for E. coli and anaerobes should be considered in patients with spontaneous perforation of pyometra.

Spontaneous Rupture of Pyometra – A Rare Cause of Peritonitis In Elderly Female

The incidence of spontaneous perforations in pyometra is rare, being 0.01-0.5% in gynaecological patients. However, they are more common in postmenopausal females and their incidence is 13.6%. Here, we are reporting a rare case of peritonitis with a pneumoperitoneum in an elderly female, which was caused by a spontaneous perforation of pyometra. A 74-years old postmenopausal female with uncontrolled diabetes mellitus was admitted to surgical emergency with signs of diffuse peritonitis and she was in shock. After resuscitation, an emergency laparotomy was performed because of suspicion of a hollow viscous perforation with peritonitis. At laparotomy, about 2000ml of purulent fluid was found to be present in peritoneal cavity, while alimentary tract was intact. A rent with a diameter of 0.8 cm was found on fundus of uterus. A total abdominal hysterectomy with a bilateral salphingo oophorectomy was performed. Patient got discharged on 12(th) post-operative day without major complications. Histopathological studies revealed endometritis and myometritis, with no evidence of malignancy.

Spontaneous Perforation of Pyometra Resulting in Peritonitis in a Postmenopausal Woman

Spontaneous Perforation of Pyometra Resulting in Peritonitis in a Postmenopausal Woman Perforation of pyometra with resultant peritonitis is rare. Herein we present a case of a postmenopausal woman who presented with an acute abdomen from perforated pyometra. Considering the increasing proportion of elderly population, this condition may increase in incidence.

Spontaneous Perforation of Pyometra: Total Abdominal Hysterectomy

Background: This case report describes an uncommon complication of generalized peritonitis following spontaneous perforation of pyometra. Case: A 60-year-old postmenopausal woman presented with clinical features of acute abdomen, and she was later diagnosed with pyometra perforation after a computed tomography scan. Laparotomy was performed, followed by a total abdominal hysterectomy with a bilateral salpingo-oopherectomy. Results: The patient died on her third postoperative day. Conclusions: Spontaneous pyometra perforation is a rare clinical condition; yet, it should be suspected and kept in the differential diagnosis of acute abdomen in elderly women. (J GYNECOL SURG 28:234)

Free Air in the Abdomen

An 85-year-old woman presented with abdominal fullness and loss of appetite for 1 day. She came to the Emergency Department (ED) due to progressive, diffuse abdominal pain. A history of peptic ulcer disease and a T-spine compression fracture were noted. Due to severe back pain, non-steroidal anti-inflammatory drugs and steroids were prescribed for pain control. In the ED, the temperature was 38.5°C, and leukocytosis (white blood cell count 18,960/mm3; 80% neutrophils) was noted. The physical examination revealed diffuse abdominal pain with peritoneal signs. A radiograph of the kidneys, ureter, and bladder showed distended loops of bowel and an ileus. An abdominal computed tomography scan showed abundant ascites with intra-abdominal free air (Figure 1). Small air bubbles in the uterine cavity was also noted (Figure 2). Under the impression of peritonitis and suspected hollow organ perforation, a diagnostic laparoscopy was performed. At the time of laparoscopy, purulent ascites was noted (> 300 mL). No peptic ulcer perforation was noted. Inspection of the bowel from the ligament of Treitz to the rectum revealed no bowel lesions. In the pelvic cavity, the uterus was noted to have a fundal perforation, 1 cm in diameter (Figure 3). The final diagnosis was pyometra (Video 1), and a total hysterectomy with bilateral salpingo-oophorectomy was performed.Figure 2Abdominal computed tomography showed much ascites with intra-abdominal free air (arrow 1). A small air bubble in the uterus cavity provided a clue for pre-operative diagnosis of pyometra (arrow 2).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Spontaneous perforation of pyometra with purulent fluid exuding from the lesion on compression was noted.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The etiology of pyometras varies; most pyometras result from occlusion of the cervical canal secondary to malignant or benign tumors, radiation cervicitis, atrophic cervicitis, puerperal infections, and congenital anomalies (1Inui A. Nitta A. Yamamoto A. et al.Generalized peritonitis with pneumoperitoneum caused by the spontaneous perforation of pyometra without malignancy: report of a case.Surg Today. 1999; 29: 935-938Crossref PubMed Scopus (31) Google Scholar). Spontaneous perforation of the uterus is thought to occur at a site of degenerative or necrotic changes after a pyometra develops, due to impairment of natural drainage via the cervix. Generalized peritonitis after spontaneous perforation of a pyometra is very rare (2Yildizhan B. Uyar E. Sişmanoğlu A. et al.Spontaneous perforation of pyometra.Infect Dis Obstet Gynecol. 2006; 2006 (26786)Crossref PubMed Scopus (55) Google Scholar). Establishing a pre-operative diagnosis for pyometras is usually difficult because the classic symptoms of vaginal discharge, lower abdominal pain, and uterine enlargement are all non-specific. In our case, small air bubbles in the uterine cavity provided a clue for the correct pre-operative diagnosis. A pelvic examination was not performed in our patient pre-operatively because pneumoperitoneum (the presence of free air on the abdominal computed tomography scan) led us to incorrectly diagnose perforation of the gastrointestinal tract. In patients who have generalized peritonitis caused by perforated pyometra with a pneumoperitoneum, anaerobic bacteria are usually detected by culture, but only Escherichia coli was detected in our patient. E. coli infections are considered to be caused by the anatomic relationship between the vagina and anus, and the decrease in lactobacilli accompanied by lowering estrogen levels in elderly women (3Ou Y.C. Lan K.C. Lin H. et al.Clinical characteristics of perforated pyometra and impending perforation: specific issues in gynecological emergency.J Obstet Gynaecol Res. 2010; 36: 661-666Crossref PubMed Scopus (35) Google Scholar). When peritonitis caused by perforated pyometra is diagnosed, emergency surgery is indicated. Although this condition is very rare, it must be considered in the differential diagnosis of generalized peritonitis in elderly women. Download .mpg (18.48 MB) Help with mpg files Video 1Much dirty fluid accumulated in the peritoneal cavity. Spontaneous perforation of pyometra with purulent fluid exuding from the lesion on compression was noted.

Spontaneous perforation of pyometra due to acute necrotising endometritis

A 64-year-old woman presented with a 1-day history of severe lower abdominal pain and pyrexia. Her medical history included a sarcoma of her left thigh treated with neo-adjuvant radiotherapy and subsequent surgical resection 2 years earlier. Wound necrosis requiring left groin reconstruction with a right rectus abdominis myocutaneous fl ap complicated her postoperative course. A massively distended air and fl uid-fi lled endometrial cavity, with marked thickening and enhancement of the myometrium was shown at CT. In the region of the left uterine fundus, there was a transmural defect containing multiple locules of air, suggesting a localised uterine perforation (Figure 1). Free intraperitoneal air and fl uid was present, with further locules of air and interloop fl uid identifi ed in the region of the duodenojejunal fl exure. An area of polypoid soft tissue was identifi ed in the lower uterine segment on the right, projecting into the uterine cavity (Figure 2). Pyometra with associated uterine perforation was suspected, and, given the history of prior sarcoma, the possibility of an underlying necrotic, perforated uterine tumour was considered. Th e diff erential diagnosis also included a secondary, localised small bowel perforation in the region of the duodenojejunal fl exure and interloop abscess. At laparotomy, there were 2 litres of frank pus in the peritoneal cavity. Th e uterus was grossly distended and a left myometrial perforation oozed purulent discharge. Secondary peritonitis involving the small and large bowel with multiple pockets of intramesenteric pus and locules of gas was also present, although there was no evidence of overt bowel perforation. In addition, signifi cant radiotherapy eff ect was present in the pelvic tissues. A total abdominal hysterectomy and bilateral salpingooophorectomy along with extensive peritoneal lavage was performed. Histological examination of the resected specimen showed marked myometrial thickening associated with dilatation of the endometrial cavity. Th e endometrium was ulcerated and covered with a haemorrhagic, grey – green exudate. Th e fi nal histological diagnosis was acute suppurative necrotising endometritis with abscess formation, full thickness necrosis of the uterine wall and serositis. Th ere was no evidence of malignancy. A 1.8 1.0 0.6 cm polypoid sub-mucosal fi broid was present in the lower uterine segment on the right, corresponding with the CT fi ndings. Its position, together with the adjacent radiotherapy eff ect, seemed to contribute to impaired drainage of the uterine cavity and subsequent development of pyometra in this patient.

Spontaneous perforation of pyometra in a cervical cancer patient: a case report and literature review

Pyometra is an uncommon condition with an incidence of less than 1% in gynaecologic patients. Spontaneous rupture of pyometra in cervical cancer presenting as generalized peritonitis is very rare. Only four cases have been described in the English literature to the best of our knowledge and from a PubMed search. The index case is an elderly postmenopausal female who was diagnosed with cervical cancer, started on radiotherapy and presented with features of generalized peritonitis. Contrast-enhanced CT revealed uterine perforation at the fundus with multiple abdominal and pelvic collections. A brief review of all the cases of ruptured pyometra in cervical cancer in the literature and a discussion of the role of imaging is presented.

Computed tomography features of spontaneously perforated pyometra: a case report

Spontaneous perforation of pyometra is an extremely rare emergent gynecologic disease. We report a 73-year-old woman with a spontaneously perforated pyometra presenting with acute abdomen in the emergency department. A dedicated computed tomography examination of the abdominal and pelvic regions revealed the diagnosis. The patient recovered well after surgical intervention and antibiotic treatment.

Generalized Peritonitis with Pneumoperitoneum Caused by the Spontaneous Perforation of Pyometra: A Case Report

Generalized Peritonitis with Pneumoperitoneum Caused by the Spontaneous Perforation of Pyometra: A Case Report

Pyometra: What Is Its Clinical Significance?

OBJECTIVE: To evaluate the clinical outcomes of pyometra. STUDY DESIGN: Retrospective study conducted between 1993 and 1999 in two regional hospitals. RESULTS: Pyometra represented 0.038% of gynecologic admissions. Of the 27 women with pyometra 6 (22.2%) cases were associated with malignancy 1 (3.7%) was associated with genital tract abnormality and 20 (74.1%) were idiopathic. Patients with idiopathic pyometra tended to be older and had a higher incidence of concurrent medical conditions. Five (18.5) women experienced spontaneous perforation of pyometra. A preoperative diagnosis was correctly made in 17 of 22 (77.3%) patients without spontaneous perforation. Most women were treated with dilatation of the cervix and drainage. Nine women (33.3%) had persistent or recurrent pyometra; three of them were asypmtomatic. CONCLUSION: Pyometra is an uncommon condition but the incidence of associated malignancy is considerable and the risk of spontaneous perforation is higher than previously thought. Dilation and drainage is the treatment of choice and regular monitoring after initial treatment is warranted to detect persistent and recurrent disease. (authors)

Generalized Peritonitis with Pneumoperitoneum Caused by the Spontaneous Perforation of Pyometra Without Malignancy: Report of a Case

Generalized Peritonitis with Pneumoperitoneum Caused by the Spontaneous Perforation of Pyometra Without Malignancy: Report of a Case

Spontaneous Perforation of Pyometra: A Case Report

Spontaneous perforation is a rare complication of pyometra and is usually associated with uterine cervical occlusion. We report a very rare case of spontaneously perforated pyometra without cervical occlusion. A 56-year-old woman with severe abdominal pain was admitted to our hospital. Exploratory laparotomy was performed because of suspicion of gastro-intestinal perforation with generalized peritonitis. There was no perforation of the stomach, gallbladder, or bowels, but examination of the uterus revealed a perforation of the uterine fundus. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, the condition must be born in mind with regard to elderly women with acute abdominal pain.