Generalized peritonitis secondary to spontaneous perforation of pyometra in a 63-year-old patient

Generalized Peritonitis Secondary to Perforated Uterine Pyometra

Generalized peritonitis with sepsis is a common general surgery emergency. The most likely implicated structure for generalized peritonitis with pneumoperitoneum is the gastrointestinal tract with urgent explorative laparotomy being the most definitive treatment. In this particular case, perforated diverticulitis was suspected and upon an exploration of the abdomen, frank pus in the setting of normal colon was noted. Some common differential diagnoses for frank pus in the abdomen include viscus perforation, pancreatic necrosis, gangrenous cholecystitis, or penetrating abdominal trauma. Here, we report a rare occurrence of peritonitis secondary to uterine rupture from pyometra.

Postoperative Streptococcus constellatus Bacteremia in a 75-Year-Old Patient with Pyometra: A Case Report

Patient: Female, 75-year-old

Final Diagnosis: Bacteremia • pyometra

Symptoms: Fever • vaginal discharge

Medication: —

Clinical Procedure: Curettage • drainage

Specialty: Infectious Diseases • Obstetrics and Gynecology

Spontaneous uterine perforation of pyometra presenting as acute abdomen

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.