1
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Jang S, Jeon M, Mun SJ, Kim SH. Clinical characteristics and risk factors for septic shock in patients with pyometra: A retrospective multicenter cohort study. J Infect Public Health 2024; 17:862-867. [PMID: 38554592 DOI: 10.1016/j.jiph.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Pyometra is a disease characterized by the collection of pus in the uterus. The clinical characteristics and etiology of pyometra have not been sufficiently described. In this study, we investigated the clinical characteristics, epidemiology, outcomes, and risk factors of septic shock in patients with pyometra. METHODS Patients with pyometra admitted to one of four university-affiliated hospitals between January 2010 to August 2022 were enrolled. Pyometra cases associated with peripartum infection and surgical site infection were excluded. Clinical characteristics and outcomes of pyometra were described, and pyometra patients with or without septic shock were compared. RESULTS A total of 192 patients was included. Twenty-eight-day all-cause mortality was 5.0%, and the 1-year recurrence rate was 6.3%. Median patient age was 77.5 years. The two most common symptoms were abdominal pain (49.0%) and vaginal discharge (47.9%). Escherichia coli (40.1%), Klebsiella pneumoniae (16.7%), and Streptococcus spp.(16.0%) were the pathogens most frequently isolated by conventional culture; those isolated from polymerase chain reaction were Mycoplasma hominis (48.0%), and Ureaplasma spp. (32.0%). In multivariable analysis, fever, uterine perforation, and dementia were associated with increased incidence of septic shock, while vaginal discharge was associated with a lower incidence of septic shock. CONCLUSIONS Our findings suggest that pyometra is a unique gynecological infectious syndrome in post-menopausal individuals. The most common associated pathogens are similar to those involved in urinary tract infections rather than those of sexually transmitted diseases. Decreased cognitive function could delay early diagnosis of pyometra and lead to septic shock and higher mortality.
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Affiliation(s)
- Sukbin Jang
- Division of Infectious Diseases, Department of Medicine, Dankook University School of Medicine, Cheonan, Republic of Korea
| | - Minji Jeon
- Division of Infectious Diseases, Department of Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Seok Jun Mun
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Si-Ho Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
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2
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Browne IL. Spontaneous perforation of pyometra—is hysterectomy required in the emergent setting? A case report and literature review. J Surg Case Rep 2022; 2022:rjac388. [PMID: 36051005 PMCID: PMC9427201 DOI: 10.1093/jscr/rjac388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/06/2022] [Indexed: 11/25/2022] Open
Abstract
Spontaneous perforation of pyometra is a rare event associated with significant morbidity and mortality when diffuse peritonitis is present. While malignant lesions of the cervical tract are the most common cause of pyometra, several benign conditions can contribute to this diagnosis. Traditionally hysterectomy has been the surgical approach of choice for this clinical entity; however, in the setting of septic shock, temporizing techniques may offer the opportunity to stabilize patients and complete a thorough work up before committing to definitive resection. This report explores a case of septic shock secondary to spontaneous perforation of pyometra that was definitively managed with peritoneal lavage and wide drainage. Intraoperative hysteroscopy and uterine biopsy were performed, and no malignancy was identified on final pathology. Intraoperative hysteroscopy along with peritoneal lavage and wide drainage may reduce the morbidity and mortality associated with sepsis from spontaneous perforation of pyometra and potentially avoid unnecessary hysterectomy.
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Affiliation(s)
- Ikennah L Browne
- Department of Surgery, University of Calgary, Cumming School of Medicine , Calgary, Alberta, Canada
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3
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Mannion A, McGee W, Feng Y, Shen Z, Buckley-Jordan E, Dzink-Fox JL, Fox JG. Characterization of genotoxin-encoding Escherichia coli isolated from specific-pathogen free cats with impaired fertility. Vet Microbiol 2022; 266:109337. [DOI: 10.1016/j.vetmic.2022.109337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/18/2021] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
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4
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Li XL, Lin J. Spontaneous uterine perforation of pyometra leads to acute abdominal pain and septic shock: a case report. World J Emerg Med 2022; 13:504-506. [PMID: 36636573 PMCID: PMC9807394 DOI: 10.5847/wjem.j.1920-8642.2022.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/26/2022] [Indexed: 01/16/2023] Open
Affiliation(s)
- Xiao-li Li
- Department of Gynecology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jun Lin
- Department of General Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China,Corresponding Author: Jun Lin,
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5
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Walthall L, Heincelman M. Pyometra: An Atypical Cause of Abdominal Pain. J Investig Med High Impact Case Rep 2021; 9:23247096211022481. [PMID: 34105423 PMCID: PMC8193658 DOI: 10.1177/23247096211022481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.
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6
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Matsubara S. Uterine irrigation for pyometra. J Obstet Gynaecol Res 2021; 47:1205-1206. [PMID: 33403760 DOI: 10.1111/jog.14642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.,Department of Obstetrics and Gynecology, Koga Red Cross Hospital, Ibaraki, Japan
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7
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Damage Control Management of Perforating Pyometra Presenting with Septic Shock after the Return of Spontaneous Circulation. Case Rep Med 2020; 2020:8545232. [PMID: 33273927 PMCID: PMC7695505 DOI: 10.1155/2020/8545232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/18/2020] [Accepted: 11/09/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Perforation of pyometra is often severe but rare. We report a case of pyometra detected on second-look surgery in an elderly patient with life-threatening septic shock and cardiopulmonary arrest before hospital arrival. Case Presentation. A 70-year-old woman with cardiopulmonary arrest received adrenaline. Computed tomography revealed ascites, and abdominal paracentesis was performed to identify the cause of cardiopulmonary arrest. The ascitic fluid was purulent, and intraperitoneal infection was identified. Emergency exploratory laparotomy revealed pyometra. Conclusion If perforated, pyometra may cause peritonitis and lethal septic shock. Not only gynecologists but also emergency physicians should be aware of this possibility. Moreover, patient education is necessary. In patients with cardiopulmonary arrest, diagnostic abdominal paracentesis should be performed when the sole imaging finding is ascites. Improving outcomes in patients with difficult-to-diagnose pyometra with cardiopulmonary arrest by implementing damage control strategies before hysterectomy is possible.
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8
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Singh P, Malhotra V, Nanda S, Chauhan MB. Spontaneous Perforation of Pyometra: A Case Series and Review of the Literature. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Parul Singh
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Vani Malhotra
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Smiti Nanda
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Meenakshi Barsaul Chauhan
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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9
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Morani AC, Hanafy AK, Marcal LP, Subbiah V, Le O, Bathala TK, Elsayes KM. Imaging of acute abdomen in cancer patients. Abdom Radiol (NY) 2020; 45:2287-2304. [PMID: 31758230 DOI: 10.1007/s00261-019-02332-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The pattern of disease causing acute abdominal pain has changed over last few decades, some of this has been attributed to intraabdominal cancers. The most common acute abdominal complaints in cancer patients are related to the gastrointestinal system. Abdominal emergencies in cancer patients can result from the underlying malignancy itself, cancer therapy and/or result from the standard pathologies causing acute abdomen in otherwise healthy population. Therapy-related or disease-related immunosuppression or high dose analgesics often blunt many of the findings which are usually expected in non-cancer general population. This complicates the clinical picture rendering the clinical exam less reliable in many cancer patients, and resulting in different pathologies which clinicians and the radiologists should remain aware of. This article focuses on imaging illustrations with differential diagnosis for various emergency scenarios related to acute abdomen specifically in oncologic settings.
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Affiliation(s)
- Ajaykumar C Morani
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA.
| | - Abdelrahman K Hanafy
- Diagnostic Radiology, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, 78229, USA
| | - Leonardo P Marcal
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Vivek Subbiah
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ott Le
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Tharakeshwara K Bathala
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
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10
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Yazawa H, Imaizumi K. Generalized peritonitis secondary to spontaneously perforated pyometra in elderly women:two cases with different clinical courses and surgical approaches and review of the literature. Fukushima J Med Sci 2020; 66:53-59. [PMID: 32281585 PMCID: PMC7269882 DOI: 10.5387/fms.2019-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe two cases of spontaneously perforated pyometra (SPP) in elderly women treated with two different surgical approaches. An 88-year-old woman underwent emergency laparotomy for presumed diagnosis of gastrointestinal (GI) tract perforation. During surgery, SPP and a tumor of the sigmoid colon were identified. Total hysterectomy and sigmoid colon resection were performed. Despite exhaustive postoperative treatments, the patient died on postoperative day (POD) 189 due to peritonitis and pneumonia. A 93-year-old woman with acute abdomen was diagnosed with severe pyometra and primarily treated with transcervical drainage. Due to progression of generalized peritonitis, laparoscopic surgery was performed. Intraoperatively, scar from a uterine body perforation was identified, leading to the diagnosis of SPP. Only peritoneal irrigation and drainage were performed, in consideration of her advanced age. She improved and was discharged from the hospital on POD 35. The prognosis for SPP is sometimes poor, especially in older women. Minimally invasive surgical intervention might be considered for primary treatment in such cases.
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Affiliation(s)
- Hiroyuki Yazawa
- Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital
| | - Karin Imaizumi
- Department of Obstetrics and Gynecology, Iwase General Hospital
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11
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A potential species of next-generation probiotics? The dark and light sides of Bacteroides fragilis in health. Food Res Int 2019; 126:108590. [PMID: 31732047 DOI: 10.1016/j.foodres.2019.108590] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 02/07/2023]
Abstract
Bacteroides fragilis (B. fragilis) is a commensal Gram-negative obligate anaerobe that resides in the mammalian lower gut and can profoundly affect the susceptibility of the host to inflammatory diseases. Previous studies have identified B. fragilis as a common opportunistic pathogen in clinical infections and suggested that it may be responsible for a range of diseases involving a permeable intestinal barrier. However, recent studies of the relationship between nontoxigenic B. fragilis and the immune system have indicated that several B. fragilis strains may be potential probiotic. In the present review, we summarize the factors influencing the intestinal abundance of B. fragilis and discuss the biological interactions between this microbe and the host. Immune system development, age, individual dietary habits, physical condition, drug intake and personal lifestyle habits can all affect the abundance of B. fragilis in the human intestine. Polysaccharide A or outer membrane vesicles from nontoxigenic B. fragilis may mediate beneficial interactions with the host, whereas enterotoxigenic B. fragilis toxin or lipopolysaccharide may stimulate colitis or even systemic inflammation. Generally, this review summarizes the biological characteristics of B. fragilis and describes future application of probiotics.
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12
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McLeod N, Lastinger A. Pyometra due to Pseudomonas aeruginosa. IDCases 2019; 17:e00554. [PMID: 31193089 PMCID: PMC6517525 DOI: 10.1016/j.idcr.2019.e00554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 11/15/2022] Open
Abstract
Pyometra is an unusual presentation of uterine infection, this condition is characterized by purulent fluid within the uterine cavity. In this report we describe pyometra due to Pseudomonas aeruginosa in a 90-year-old woman who presented with abdominal pain, nausea with emesis and diarrhea. She was evaluated at an outside emergency department and computed tomography (CT) revealed a large, complex, cystic mass measuring 9.2 cm (cm) in greatest diameter. Given her age, the diagnosis of malignancy was entertained. She was referred to gynecologic-oncology service for evaluation and underwent exploratory laparotomy with total abdominal hysterectomy and lysis of adhesions. Intraoperative findings were consistent with pyometra. Cultures ultimately grew Pseudomonas aeruginosa. She initiated on antibacterial therapy and was discharged to a rehabilitation facility.
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Affiliation(s)
- Nathan McLeod
- Department of Medicine, Section of Infectious Diseases, PO Box 9163, West Virginia University School of Medicine, Morgantown, WV, 26506-9214, United States
| | - Allison Lastinger
- Department of Medicine, Section of Infectious Diseases, PO Box 9163, West Virginia University School of Medicine, Morgantown, WV, 26506-9214, United States
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13
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Balas Ş, Yılmaz KB, Yıldırım SA, Açıkgöz B, Tatar İG, Bayar B, Akıncı M, Kaya O. Spontaneous perforation of pyometra: A rare cause of acute abdomen and sepsis. Turk J Surg 2018; 34:342-345. [PMID: 30664439 DOI: 10.5152/turkjsurg.2017.3203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 05/06/2016] [Indexed: 11/22/2022]
Abstract
Pyometra, the accumulation of purulent material in the uterine cavity, is a rare gynecological condition whose etiology is impaired drainage of the uterine cavity. It is uncommon in premenopausal age and occurs mainly in older and postmenopausal women. Clinical signs of pyometra are vaginal discharge, postmenopausal bleeding, and lower abdominal pain. An 87-year-old woman was admitted to our emergency department with abdominal pain, fever, and vomiting. The results of physical examination revealed rebound tenderness and muscular rigidity in the lower abdomen. Ultrasonography demonstrated free fluid in the abdomen, and percutaneous aspiration revealed that this fluid was purulent. A computed tomography scan showed a large amount of free fluid in the abdominal cavity and a uterine myoma. The patient underwent emergency laparotomy due to acute abdomen. During the laparotomy, a 2×1 cm perforation was seen at the fundus of the uterus. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. A culture of the pus grew Escherichia coli. Histopathological examination revealed degenerative uterine myoma with no evidence of malignancy. Pathological results indicated myometrial suppurative inflammation along with neutrophilia and necrosis. Pyometra is a rare event; however, it must be considered when investigating acute abdomen etiology. Because pyometra involves abscess formation, drainage and evacuation of the uterine cavity while leaving a drain in the cavity and dilating the cervical canal is the main treatment protocol. In cases of perforation, hysterectomy is the treatment choice; however, with concomitant diseases in older patients, immediate surgery is related to important morbidity and mortality risks.
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Affiliation(s)
- Şener Balas
- Clinic of General Surgery, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Kerim Bora Yılmaz
- Clinic of General Surgery, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Seray Akçalar Yıldırım
- Clinic of Radiology, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Bilgihan Açıkgöz
- Clinic of Pathology, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - İdil Güneş Tatar
- Clinic of Radiology, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Bahattin Bayar
- Clinic of General Surgery, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Melih Akıncı
- Clinic of General Surgery, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Oskay Kaya
- Clinic of General Surgery, Health Science University Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
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14
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Nielsen KE, Medeck SA, Brillhart DB, Mayclin KJ. Pyometra, an Unusual Case of Acute Abdomen. Clin Pract Cases Emerg Med 2018; 2:241-243. [PMID: 30083642 PMCID: PMC6075499 DOI: 10.5811/cpcem.2018.5.38221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/27/2018] [Accepted: 05/03/2018] [Indexed: 11/18/2022] Open
Abstract
A 49-year-old female six days post-endometrial biopsy presented to the emergency department with constant severe suprapubic abdominal pain, fevers and myalgia. A contrasted computed tomography noted an intrauterine fluid collection and a final diagnosis of pyometra was made in the operating room following total hysterectomy. Pyometra is an exceptionally rare clinical condition with significant mortality.
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Affiliation(s)
- Kyle E Nielsen
- Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Hood, Texas
| | - Sarah A Medeck
- Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Hood, Texas
| | - Dan B Brillhart
- Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Hood, Texas
| | - Kasey J Mayclin
- Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Hood, Texas
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15
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Emergui Zrihen Y, Obreros Zegarra LP, García Hernández JA. Spontaneous uterine rupture due to pyometra, a case report. Eur J Obstet Gynecol Reprod Biol 2017; 217:182-183. [PMID: 28899567 DOI: 10.1016/j.ejogrb.2017.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Y Emergui Zrihen
- Avenida Marítima del Sur, s/n, 35016 Las Palmas de Gran Canaria, Spain.
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16
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Perforative Peritonitis-Gastrointestinal Tract May Not Always Be the Source. Indian J Surg 2017; 79:160-162. [PMID: 28442845 DOI: 10.1007/s12262-016-1460-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 02/15/2016] [Indexed: 10/22/2022] Open
Abstract
Perforative peritonitis is the most common surgical emergency in general surgical practice. Gastrointestinal perforation is the etiology in the vast majority of the patients. However, occasionally, other rare causes may be encountered. One such cause of peritonitis is spontaneous perforation of non-gravid uterus. Uterine perforation is a potential complication of any intrauterine procedure and may be associated with injury to surrounding blood vessels or viscera such as the urinary bladder or intestine. Spontaneous uterine perforation is rare and less than 50 cases have been reported in the English literature. We are presenting two such cases of spontaneous perforation of the uterus in elderly postmenopausal women which presented with generalized peritonitis and were clinically indistinguishable from gastrointestinal perforation.
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17
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Konishi Y, Kagabu S, Mori K, Kato M. Uterine perforation of pyometra in a cervical cancer: A case report and literature review. J OBSTET GYNAECOL 2016; 36:378-9. [PMID: 26977976 DOI: 10.3109/01443615.2015.1072809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Y Konishi
- a Department of Obstetrics and Gynecology , Nakadori General Hospital , Akita , Japan
| | - S Kagabu
- a Department of Obstetrics and Gynecology , Nakadori General Hospital , Akita , Japan
| | - K Mori
- a Department of Obstetrics and Gynecology , Nakadori General Hospital , Akita , Japan
| | - M Kato
- a Department of Obstetrics and Gynecology , Nakadori General Hospital , Akita , Japan
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18
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Uno K, Tano S, Yoshihara M, Mayama M, Ukai M, Kishigami Y, Nishikawa Y, Takeichi Y, Oguchi H. A Case Report and Literature Review of Spontaneous Perforation of Pyometra. J Emerg Med 2016; 50:e231-6. [PMID: 26994838 DOI: 10.1016/j.jemermed.2016.01.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 01/04/2016] [Accepted: 01/21/2016] [Indexed: 12/15/2022]
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. CASE REPORT 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.
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Affiliation(s)
- Kaname Uno
- Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - Sho Tano
- Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - Masato Yoshihara
- Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - Michinori Mayama
- Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - Mayu Ukai
- Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - Yasuyuki Kishigami
- Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - Yoshitomo Nishikawa
- Department of Emergency Medicine, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - Yasushi Takeichi
- Department of Emergency Medicine, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - Hidenori Oguchi
- Department of Obstetrics, Perinatal Medical Center, Toyota Memorial Hospital, Toyota, Aichi, Japan
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İşlek Seçen E, Ağış H, Altunkaya C, Avşar AF. Postmenopausal spontaneous uterine perforation: Case report. Turk J Obstet Gynecol 2015; 12:122-124. [PMID: 28913055 PMCID: PMC5558376 DOI: 10.4274/tjod.70370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/21/2015] [Indexed: 12/01/2022] Open
Abstract
Spontaneous uterine rupture and generalized peritonitis caused by pyometra occurs rarely with high morbidity and mortality. A correct and definite diagnosis can be made with laparotomy or laparoscopy. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and gynecologic symptoms are less frequent, which makes preoperative diagnosis difficult. We report a case of a patient aged 82 years who underwent surgery for spontaneous uterine rupture and generalized peritonitis as a result of pyometra.
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Affiliation(s)
- Elçin İşlek Seçen
- Atatürk Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Hilal Ağış
- Atatürk Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Canan Altunkaya
- Atatürk Training and Research Hospital, Clinic of Pathology, Ankara, Turkey
| | - Ayşe Filiz Avşar
- Yıldırım Beyazıt University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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Singh A, Mundhra R, Agarwal T, Radhakrishnan G. Spontaneous rupture of pyometra manifesting as an acute abdomen: a case report. Trop Doct 2015; 45:200-3. [PMID: 25999354 DOI: 10.1177/0049475515587167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spontaneous perforation of pyometra is a rare entity with a reported incidence in the range of 0.01-0.05%. The clinical picture is similar to peritonitis arising from intestinal perforation and commonly the correct diagnosis is only made perioperatively. We report a case in an elderly postmenopausal woman presenting with an acute abdomen.
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Affiliation(s)
- Alpana Singh
- Assistant Professor, Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital, Delhi, India
| | - Rajlaxmi Mundhra
- Senior Resident, Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital, Delhi, India
| | - Tannavi Agarwal
- Senior Resident, Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital, Delhi, India
| | - Gita Radhakrishnan
- Professor and Head of Department, Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital, Delhi, India
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Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin. Case Rep Surg 2015; 2015:548481. [PMID: 25628913 PMCID: PMC4299690 DOI: 10.1155/2015/548481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/15/2014] [Accepted: 12/20/2014] [Indexed: 11/18/2022] Open
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.
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22
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Yousefi Z, Sharifi N, Morshedy M. Spontaneous uterine perforation caused by pyometra: a case report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14491. [PMID: 25593714 PMCID: PMC4270675 DOI: 10.5812/ircmj.14491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 04/15/2014] [Accepted: 04/23/2014] [Indexed: 12/19/2022]
Abstract
Introduction: Pyometra is an accumulation of purulent material or pus in the uterine cavity. Spontaneous perforation of uterus by pyometra is rare. This is a clinical presentation and management of a spontaneous perforation of uterine caused by pyometra. Case Presentation: This is a case report on spontaneously perforated associated with pyometra secondary to cervical malignancy. The patient underwent exploratory laparotomy with total hysterectomy and bilateral salpingo-oophorectomy. Conclusions: Spontaneous rupture of pyometra duo to cervical cancer in cases of acute abdomen in elderly patients should be considered.
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Affiliation(s)
- Zohreh Yousefi
- Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding Author: Zohreh Yousefi, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5138412477, Fax: +98-5138430569, E-mail:
| | - Noorieh Sharifi
- Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Maryam Morshedy
- Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Kitai T, Okuno K, Ugaki H, Komoto Y, Fujimi S, Takemura M. Spontaneous uterine perforation of pyometra presenting as acute abdomen. Case Rep Obstet Gynecol 2014; 2014:738568. [PMID: 25057420 PMCID: PMC4095732 DOI: 10.1155/2014/738568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/30/2014] [Indexed: 11/18/2022] Open
Abstract
Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts.
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Affiliation(s)
- Toshihiro Kitai
- Departments of Obstetrics and Gynecology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka 558-0056, Japan
| | - Kentaro Okuno
- Departments of Obstetrics and Gynecology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka 558-0056, Japan
| | - Hiromi Ugaki
- Departments of Obstetrics and Gynecology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka 558-0056, Japan
| | - Yoshiko Komoto
- Departments of Obstetrics and Gynecology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka 558-0056, Japan
| | - Satoshi Fujimi
- Departments of Emergency and Critical Care, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka 558-0056, Japan
| | - Masahiko Takemura
- Departments of Obstetrics and Gynecology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka 558-0056, Japan
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Kutuk MS, Ozgun MT, Tas M, Uludag S. Spontaneous uterine perforation due to pyometra. J OBSTET GYNAECOL 2014; 33:322-3. [PMID: 23550879 DOI: 10.3109/01443615.2012.754415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M S Kutuk
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
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Epidemiology and spectrum of positive bacteriological culture in intrauterine fluid collected from women with postmenopausal bleeding. Menopause 2014; 21:794-8. [PMID: 24473531 DOI: 10.1097/gme.0000000000000182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to examine the prevalence and bacteriological findings of different types of intrauterine fluid collection in women presenting with postmenopausal bleeding and the risk factors for predicting positive microbiological culture, mixed growth, and anaerobic growth. METHODS This is a retrospective cohort study. Data from all of the women who were assessed in our one-stop postmenopausal bleeding clinic between 2008 and 2011 and who were found to have intrauterine fluid collection were reviewed. Endometrial aspirates of all women were sent for bacterial culture and histological examination. The risk factors for positive culture were assessed by both univariate and multivariate analyses. RESULTS A total of 228 cases of intrauterine fluid collection were included for analysis. There were 109 (47.8%) cases of pyometra, 98 (43.0%) cases of hydrometra, and 21 (9.2%) cases of hematometra. Escherichia coli, Bacteroides fragilis, and Enterococcus were the commonest microorganisms isolated from endometrial aspirates. Both endometrial malignancy and benign intrauterine pathologies are not risk factors for positive culture. Advanced age (>75 y) is an independent risk factor for positive culture (odds ratio, 2.89; 95% CI, 1.39-6.01) and mixed growth (odds ratio, 2.18; 95% CI, 1.02-4.67). Residency in nursing homes is an independent risk factor for mixed growth (odds ratio, 2.61; 95% CI, 1.21-5.63) and anaerobic growth (odds ratio, 2.55; 95% CI, 1.01-6.44). CONCLUSIONS E. coli, B. fragilis, and Enterococcus are the commonest microorganisms isolated from intrauterine fluid. Apart from drainage of the intrauterine fluid collection, successful management also requires appropriate antibiotics and improvement in perineal hygiene.
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Hurst N, Macht M, Travis PJ, Pierce M, Brown WW. Postmenopausal female with abdominal pain. J Emerg Med 2013; 45:e221-2. [PMID: 24012441 DOI: 10.1016/j.jemermed.2013.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/13/2013] [Accepted: 05/01/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole Hurst
- Naval Medical Center San Diego, San Diego, California
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Generalized peritonitis secondary to spontaneous perforation of pyometra in a 63-year-old patient. Case Rep Obstet Gynecol 2013; 2013:929407. [PMID: 24073347 PMCID: PMC3773424 DOI: 10.1155/2013/929407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/31/2013] [Indexed: 12/05/2022] Open
Abstract
Spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. Herein, we report the case of a 63-year-old woman who presented to emergency department with a 2-day history of severe diffuse abdominal pain, high-grade fever, nausea, and vomiting. Acute abdomen series was done, and upright plain chest radiograph showed free air under diaphragm. A noncontrast-enhanced computed tomography scan showed a significantly distended fluid-filled uterus measuring 10 × 7.8 × 10 cm, in addition to a single focus of perforation involving the uterine fundus and associated with presence of free air within the nondependant area. No evidence of ascites or pelvi-abdominal lymphadenopathy was identified. A preoperative diagnosis of generalized peritonitis secondary to spontaneous perforation of uterus was established. Subsequently, patient underwent urgent exploratory laparotomy which revealed pus-filled uterus with perforated fundus. Diagnosis of generalized peritonitis secondary to spontaneous perforation of pyometra was established. Consequently, patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, as well as thorough drainage and irrigation of pelvi-abdominal cavity. Postoperatively, patient was admitted to intensive care unit. Histopathological examination of uterus was negative for malignancy, and surgical culture grew Streptococcus constellatus. Patient had an uneventful recovery. Moreover, a brief literature review on pyometra is presented.
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28
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Patil V, Patil LS, Shiragur S, Ichalakaranji R. Spontaneous rupture of pyometra - a rare cause of peritonitis in elderly female. J Clin Diagn Res 2013; 7:1735-6. [PMID: 24086896 DOI: 10.7860/jcdr/2013/5393.3272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 06/23/2013] [Indexed: 11/24/2022]
Abstract
The incidence of spontaneous perforations in pyometra is rare, being 0.01-0.5% in gynaecological patients. However, they are more common in postmenopausal females and their incidence is 13.6%. Here, we are reporting a rare case of peritonitis with a pneumoperitoneum in an elderly female, which was caused by a spontaneous perforation of pyometra. A 74-years old postmenopausal female with uncontrolled diabetes mellitus was admitted to surgical emergency with signs of diffuse peritonitis and she was in shock. After resuscitation, an emergency laparotomy was performed because of suspicion of a hollow viscous perforation with peritonitis. At laparotomy, about 2000ml of purulent fluid was found to be present in peritoneal cavity, while alimentary tract was intact. A rent with a diameter of 0.8 cm was found on fundus of uterus. A total abdominal hysterectomy with a bilateral salphingo oophorectomy was performed. Patient got discharged on 12(th) post-operative day without major complications. Histopathological studies revealed endometritis and myometritis, with no evidence of malignancy.
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Affiliation(s)
- Vijaya Patil
- Professor, Department of General Surgery, Shri B.M. Patil Medical College , Bijapur, Karnataka - 586103, India
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29
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Tirumani SH, Ojili V, Gunabushanam G, Chintapalli KN, Ryan JG, Reinhold C. MDCT of abdominopelvic oncologic emergencies. Cancer Imaging 2013; 13:238-52. [PMID: 23876309 PMCID: PMC3719057 DOI: 10.1102/1470-7330.2013.0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acute complications arising in abdominopelvic malignancies represent a unique subset of patients presenting to the emergency room. The acute presentation can be due to complications occurring in the tumor itself or visceral or vascular structures harboring the tumor. Multidetector computed tomography (MDCT) is the investigation of choice in the workup of these patients and enables appropriate and timely management. Management of the complication depends primarily on the extent of the underlying malignancy and the involvement of other viscera. The purpose of this article is to depict the imaging features of these complications on MDCT.
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Affiliation(s)
- Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
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30
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Ikeda M, Takahashi T, Kurachi H. Spontaneous perforation of pyometra: a report of seven cases and review of the literature. Gynecol Obstet Invest 2013; 75:243-9. [PMID: 23548841 DOI: 10.1159/000349981] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 02/16/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The spontaneous perforation of pyometra is very rare and is associated with a poor prognosis. The present study aimed to evaluate the clinical characteristics and prognostic factors for patient survival. PATIENTS AND METHODS We reported on 7 patients with spontaneous rupture of pyometra. We also reviewed 47 additional published cases. Thus, all 54 patients were analyzed for mortality. RESULTS We investigated the prognosis in 44 of 54 patients, excluding 8 patients with undocumented outcome and 2 who died of other diseases. The mortality rate was 25% (11 of 44). In univariate analysis, variables such as age, correct preoperative diagnosis, comorbidities, the presence of malignancy, and hysterectomy were not significant between surviving and deceased patients. In bacterial cultures from the peritoneal cavity, the most common etiological organisms were Escherichia coli and anaerobes such as Bacteroides and Peptococcus species. The rate of isolation of anaerobic bacteria was significantly increased in patients who died (odds ratio, 6.33; 95% confidence interval, 1.28-31.02; p = 0.04). CONCLUSION Antibiotic therapy for E. coli and anaerobes should be considered in patients with spontaneous perforation of pyometra.
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Affiliation(s)
- Michi Ikeda
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan
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31
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Shapey IM, Nasser T, Dickens P, Haldar M, Solkar MH. Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum. Ann R Coll Surg Engl 2012; 94:e246-8. [PMID: 23131215 PMCID: PMC3954306 DOI: 10.1308/003588412x13373405387410] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 11/29/2022] Open
Abstract
Pneumoperitoneum is usually associated with gastrointestinal perforation or following surgical and endoscopic procedures. We report a rare case of spontaneously perforated pyometra presenting with generalised peritonitis and pneumoperitoneum. Perforation of the uterus is also unusual and often associated with the presence of an intrauterine device, a gravid uterus or malignancy. Our case illustrates the importance of clinical knowledge of acute and neoplastic gynaecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynaecology colleagues is essential as operative intervention is often required.
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Affiliation(s)
- I M Shapey
- Department of General Surgery, Tameside General Hospital, Fountain Street, Ashton-under-Lyne OL6 9RW, UK.
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32
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Lim SF, Lee SL, Chiow AKH, Foo CS, Wong ASY, Tan SM. Rare cause of acute surgical abdomen with free intraperitoneal air: Spontaneous perforated pyometra. A report of 2 cases. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:55-7. [PMID: 23569488 PMCID: PMC3616039 DOI: 10.12659/ajcr.882629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/06/2012] [Indexed: 01/27/2023]
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. CASE REPORT 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.
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Affiliation(s)
- Siew Fung Lim
- Department of Surgery, Changi General Hospital, Singapore
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33
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Liang HH, Wei PL, Liu WM, Chen CC, Yen KL, Kuo LJ, Hung CS. Free air in the abdomen. J Emerg Med 2012; 44:e93-4. [PMID: 22406027 DOI: 10.1016/j.jemermed.2012.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/15/2011] [Accepted: 01/17/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Hung-Hua Liang
- Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
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35
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Wallet F, Lunel A, Cassar E, Tassin C, Lieutaud T, Golfier F, Piriou V. [An unusual endometritis]. J Gynecol Obstet Hum Reprod 2011; 40:166-168. [PMID: 20926206 DOI: 10.1016/j.jgyn.2010.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 08/20/2010] [Accepted: 08/26/2010] [Indexed: 05/30/2023]
Abstract
We report a case of pyometra without any related risk factor. This leads to a severe septic shock. Evolution was successful because of quick surgical management. We report literature management of such infection. Although pyometra is an uncommon disease, it should be kept in mind as delayed management may lead to fatal outcome.
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Affiliation(s)
- F Wallet
- Service d'anesthésie réanimation médicale et chirurgicale, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
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