title: A Case Report and Literature Review of Spontaneous Perforation of Pyometra.
abstract: BACKGROUND
  Pyometra is defined as an accumulation of purulent material in the uterine cavity. Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen.
  
  
  METHODS
  We report a rare and difficult case of peritonitis in an elderly female that was caused by a spontaneous perforation of pyometra. A 90-year-old postmenopausal woman was referred to our hospital with complaints of vomiting, fever, and abdominal pain. Computed tomography revealed a large amount of ascites, cystic mass in the uterus, and intraperitoneal and intrauterine air. Transvaginal ultrasound demonstrated a thin area around the fundus. An emergency laparotomy was performed for the suspected gastrointestinal perforation or perforation of pyometra. At laparotomy, copious purulent fluid was present in the peritoneal cavity; however, no perforation of the gastrointestinal tract was observed. We identified a perforation site over the uterine fundus and purulent material exuding from the cavity. Subsequently, hysterectomy and bilateral salpingo-oophorectomy were performed. The patient was discharged on postoperative day 13 with no complications. Histopathologic studies revealed endometritis and myometritis with no evidence of malignancy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With diffuse peritonitis, ruptured pyometra should be considered, even in elderly female patients. This case illustrates the importance of clinical knowledge of acute gynecologic diseases. Here we also review the perforation of pyometra with no evidence of malignancy.
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Kaname
authors.initials: K
authors.lastname: Uno
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Tano
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Yoshihara
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Michinori
authors.initials: M
authors.lastname: Mayama
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Mayu
authors.initials: M
authors.lastname: Ukai
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kishigami
authors.affiliation: Department of Emergency Medicine, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Nishikawa
authors.affiliation: Department of Emergency Medicine, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takeichi
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Oguchi
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology / Q000503:physiopathology; D004636:Emergency Service, Hospital / Q000458:organization & administration; D004926:Escherichia coli / Q000187:drug effects / Q000472:pathogenicity; D005260:Female; D005334:Fever / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007813:Laparotomy / Q000379:methods; D010052:Ovariectomy; D010462:Peptostreptococcus / Q000187:drug effects / Q000472:pathogenicity; D010538:Peritonitis / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D055112:Pyometra / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D058994:Salpingectomy; D000072663:Spontaneous Perforation / Q000150:complications* / Q000503:physiopathology; D014463:Ultrasonography / Q000379:methods; D014599:Uterus / Q000000981:diagnostic imaging / Q000503:physiopathology; D019522:Vaginal Discharge / Q000209:etiology / Q000503:physiopathology; D014839:Vomiting / Q000209:etiology / Q000503:physiopathology
keywords: intrauterine air; perforation; pyometra