Spontaneous Uterine Perforation from Pyometra: A Case Report

Cho, Sukjin; Choi, Seung Woon; Kang, Tae Kyung; Kim, Hye Jin; Oh, Sung Chan; Ryu, Seok Yong

Abstract

Pyometra is the accumulation of pus in the uterine cavity. The incidence of pyometra in elderly patients is approximately 13.6%. Abdominal pain, fever, and vaginal discharge are the usual symptoms, but about half of the cases of uncomplicated pyometra have no specific symptoms. Spontaneous uterine rupture, resulting from complications of pyometra, is extremely rare. We report a case of spontaneous uterine rupture due to pyometra. A 77-year-old female patient who complained of nausea, abdominal pain, and poor oral intake (which started the day before) was transferred from the local hospital after having taken an abdominal CT. She had been bedridden for a year and had a history of hypertension, cerebral infarction, and colon cancer (for which she had a successful operation 12 years prior). Upon arrival, the patient was alert and her vital signs were: blood pressure of 113/78 mmHg, temperature of 36.9degrees C, respiratory rate of 22/min, and a pulse rate of 99/min. Her bowel sound was normal and physical examinations indicated a rigid abdomen with tenderness and rebound tenderness. Free air was observed in the abdominal CT and panperitonitis, due to uterine perforation resulting from pyometra, was also suggested. Hence, an emergency operation was undertaken. During the operation, the fundus of the uterus was found to be perforated with a 1 cmx1 cm-sized passage and a purulent discharge was apparent. Both the adnexa and bowel showed adhesion, but there was no bowel perforation or evident cancerous lesion. Entercoccus faecalis was cultured from both the cervical discharge and tissue obtained during operation. In summary, emergency physicians may consider uterine perforation due to pyometra in elderly woman with peritonitis.