title: Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: report of a case.
abstract: We report a rare case of generalized peritonitis due to a ruptured pyometra in an 86-year-old woman, and also conduct a review of the previous Japanese literature. The patient presented with muscle guarding and rebound tenderness. Computed tomography (CT) disclosed a cystic mass in the peritoneal cavity, in which an air-fluid level was noted. Pneumoperitoneum around the uterus due to gas production of anaerobic bacteria was noted on a CT. At laparotomy, the uterus was markedly enlarged with a necrotic area on the uterine fundus, which was found to be perforated. A supravaginal hysterectomy and drainage were performed. We found only eight cases of a ruptured pyometra presenting as pneumoperitoneum in the Japanese literature between 1977 and 1999. The most common cause of pneumoperitoneum is a perforation of the gastrointestinal tract. However, other possible causes, as seen in our patient, should also be taken into consideration. Although it is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.
authors.affiliation: Department of Surgery, Kurashiki Kosai Hospital, Okayama, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Nakao
authors.forename: H
authors.initials: H
authors.lastname: Mimura
authors.forename: K
authors.initials: K
authors.lastname: Fujisawa
authors.forename: K
authors.initials: K
authors.lastname: Ezawa
authors.forename: T
authors.initials: T
authors.lastname: Okamoto
authors.forename: H
authors.initials: H
authors.lastname: Iwagaki
authors.forename: H
authors.initials: H
authors.lastname: Isozaki
authors.forename: N
authors.initials: N
authors.lastname: Takakura
authors.forename: N
authors.initials: N
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001707:Biopsy, Needle; D003015:Clostridium Infections / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010538:Peritonitis / Q000175:diagnosis* / Q000209:etiology*; D011027:Pneumoperitoneum / Q000175:diagnosis* / Q000628:therapy; D013492:Suppuration / Q000150:complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014595:Uterine Perforation / Q000150:complications* / Q000175:diagnosis / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents