title: Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin.
abstract: 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.
authors: Department of Obstetrics and Gynecology, Matsunami General Hospital, Gifu 501-6062, Japan.
authors: Takahiro
authors: T
authors: Yamada
authors: Department of Surgery, Matsunami General Hospital, Gifu 501-6062, Japan.
authors: Nanako
authors: N
authors: Ando
authors: Department of Surgery, Matsunami General Hospital, Gifu 501-6062, Japan.
authors: Naoshi
authors: N
authors: Shibata
authors: Department of Surgery, Matsunami General Hospital, Gifu 501-6062, Japan.
authors: Motomu
authors: M
authors: Suitou
authors: Department of Obstetrics and Gynecology, Matsunami General Hospital, Gifu 501-6062, Japan.
authors: Hiroshi
authors: H
authors: Takagi
authors: Department of Obstetrics and Gynecology, Matsunami General Hospital, Gifu 501-6062, Japan.
authors: Kazutoshi
authors: K
authors: Matsunami
authors: Department of Obstetrics and Gynecology, Matsunami General Hospital, Gifu 501-6062, Japan.
authors: Satoshi
authors: S
authors: Ichigo
authors: Department of Obstetrics and Gynecology, Matsunami General Hospital, Gifu 501-6062, Japan ; Institute of Endocrine-Related Cancer, Matsunami General Hospital, 150-1 Dendai, Kasamatsu, Gifu 501-6062, Japan.
authors: Atsushi
authors: 0000-0003-1601-2789
authors: A
authors: Imai
references: Case Rep Obstet Gynecol. 2014;2014:738568
references: 25057420
references: Case Rep Obstet Gynecol. 2013;2013:298383
references: 24024054
references: Infect Dis Obstet Gynecol. 2006;2006:26786
references: 17093350
references: Surg Today. 2000;30(5):454-7
references: 10819486
references: Gynecol Obstet Invest. 2013;75(4):243-9
references: 23548841
references: J Obstet Gynaecol Res. 2010 Jun;36(3):661-6
references: 20598053
references: J Reprod Med. 2000 Oct;45(10):857-60
references: 11077640
references: J Reprod Infertil. 2011 Jul;12(3):235-8
references: 23926508
references: Dig Surg. 2003;20(4):334-8
references: 12806202
references: J Reprod Med. 2001 Nov;46(11):952-6
references: 11762150
references: J Clin Diagn Res. 2013 Aug;7(8):1735-6
references: 24086896
references: Can Med Assoc J. 1981 Sep 15;125(6):589-92
references: 7284938
references: Am J Surg. 1983 Dec;146(6):830-3
references: 6650772
references: Ann R Coll Surg Engl. 2012 Nov;94(8):e246-8
references: 23131215