title: Rare cause of acute surgical abdomen with free intraperitoneal air: Spontaneous perforated pyometra. A report of 2 cases.
abstract: BACKGROUND
  The acute abdomen accounts for up to 40% of all emergency surgical hospital admissions and a large proportion are secondary to gastrointestinal perforation. Studies have shown the superiority of the abdominal CT over upright chest radiographs in demonstrating free intraperitoneal air. Spontaneous perforated pyometra is a rare cause of the surgical acute abdomen with free intraperitoneal air. Only 38 cases have been reported worldwide.
  
  
  METHODS
  We report 2 cases of spontaneously perforated pyometra in our hospital's general surgery department. Both underwent exploratory laparotomy: one had a total hysterectomy and bilateral salpingo-oophorectomy, while the other had an evacuation of the uterine cavity, primary repair of uterine perforation and a peritoneal washout. A literature search was conducted and all reported cases reviewed in order to describe the clinical presentations and management of the condition. Of the 40 cases to date, including 2 of our cases, the most common presenting symptoms were abdominal pain (97.5%), fever (37.5%) and vomiting (25.0%). The main indication for exploratory laparotomy was pneumoperitoneum (97.5%).
  
  
  CONCLUSIONS
  Pyometra is an unusual but serious condition in elderly women presenting with an acute abdomen. A high index of suspicion is needed to make the appropriate diagnosis.
authors.affiliation: Department of Surgery, Changi General Hospital, Singapore.
authors.forename: Siew Fung
authors.initials: SF
authors.lastname: Lim
authors.forename: Song Liang
authors.initials: SL
authors.lastname: Lee
authors.forename: Adrian Kah Heng
authors.initials: AK
authors.lastname: Chiow
authors.forename: Chek Siang
authors.initials: CS
authors.lastname: Foo
authors.forename: Andrew Siang Yih
authors.initials: AS
authors.lastname: Wong
authors.forename: Su-Ming
authors.initials: SM
authors.lastname: Tan
keywords: acute abdomen; free intra-peritoneal air; pyometra