Postmenopausal spontaneous rupture of pyometra

Authors

  • Aruna Verma Department of Obstetrics and Gynecology, L. L. R. M. Medical College, Meerut, Uttar Pradesh, India
  • Raghavi Maheshwari Department of Obstetrics and Gynecology, L. L. R. M. Medical College, Meerut, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20220927

Keywords:

Pyometra, Uterine perforation, Postmenopausal

Abstract

Spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon, ranging from 0.01% to 0.5%. Herein, we report the case of a 55 year old postmenopausal woman, presented with acute abdominal pain, distended abdomen, and inability to pass flatus and feces, and purulent vaginal discharge. In view of generalized peritonitis, laparotomy was performed on which 3000 cc pus was suctioned out and necrotic tissue was found on the surface of liver and intestines. The uterus was found to have a 2×2 cm sized perforation at fundo-posterior surface from which purulent material was seen exuding. Thus, a diagnosis of perforated uterus due to pyometra was made. A total abdominal hysterectomy with bilateral salpingo-oophorectomy with thorough peritoneal lavage was done. Histopathological examination revealed perforated uterus with pyometra, but there was no evidence of malignancy, and the cervical canal was patent. The patient had burst abdomen on 6th postoperative day and subsequent resuturing was done. She was discharged on 17th postoperative day in satisfactory condition. Thus, rarely, perforation of uterus due to pyometra can cause peritonitis in postmenopausal females with signs of acute abdomen.

Author Biographies

Aruna Verma, Department of Obstetrics and Gynecology, L. L. R. M. Medical College, Meerut, Uttar Pradesh, India

Professorin, Department of Obstetrics & Gynecology, LLRM MedicalCollege, Meerut, U.P., India

Raghavi Maheshwari, Department of Obstetrics and Gynecology, L. L. R. M. Medical College, Meerut, Uttar Pradesh, India

Department of Obstetrics and Gynaecology, LLRM Medical College, Meerut, UP, India

References

Nielsen KE, Medeck SA, Brillhart DB, Mayclin KJ. Pyometra, an Unusual Case of Acute Abdomen. Clin Pract Cases Emerg Med. 2018;2(3):241-3.

Huang Y, Qifang T. Postmenopausal spontaneous rupture of pyometra. Medicine. 2018;97(52):e13659.

Malvadkar SM, Malvadkar MS, Domkundwar SV. Spontaneous rupture of pyometra causing peritonitis in elderly female diagnosed on dynamic transvaginal ultrasound. Case Rep Radiol. 2016;1738521.

Yin WB, Wei YH, Liu GW, Zhao XT, Zhang MS, Hu JL, Zhang NY, Lu Y. Spontaneous perforation of pyometra presenting as acute abdomen: a rare condition with considerable mortality. Am J Emerg Med. 2016;34(4):761.

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Published

2022-03-25

Issue

Section

Case Reports