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Chen YC, Chuang YC, Lu HF, Torng PL. A 75-year-old woman with sudden onset of whole abdominal pain. Asian J Surg 2023; 46:1248-1249. [PMID: 36244903 DOI: 10.1016/j.asjsur.2022.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Yen-Cheng Chen
- Department of Obstetrics and Gynecology, Far Eastern, Memorial Hospital, New Taipei, Taiwan
| | - Yi-Chen Chuang
- Department of Obstetrics and Gynecology, Far Eastern, Memorial Hospital, New Taipei, Taiwan; Department of Obstetrics and Gynecology, Hsin-Chu Br, National Taiwan University Hospital, Hsin Chu, Taiwan.
| | - Hsin-Fen Lu
- Department of Obstetrics and Gynecology, Far Eastern, Memorial Hospital, New Taipei, Taiwan
| | - Pao-Ling Torng
- Department of Obstetrics and Gynecology, Hsin-Chu Br, National Taiwan University Hospital, Hsin Chu, Taiwan
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2
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Matsumoto R, Kuramoto S, Muronoi T, Oka K, Shimojyo Y, Kidani A, Hira E, Watanabe H. Damage control surgery for spontaneous perforation of pyometra with septic shock: a case report. Acute Med Surg 2021; 8:e657. [PMID: 34026231 PMCID: PMC8133080 DOI: 10.1002/ams2.657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/11/2022] Open
Abstract
Background Although spontaneous perforation of pyometra is very rare, it sometimes causes severe peritonitis, leading to lethal conditions. Damage control surgery reportedly improves the survival of critically ill patients; however, there has been no report describing damage control surgery for ruptured pyometra. Case presentation An 83‐year‐old postmenopausal woman with generalized peritonitis and septic shock was admitted and underwent emergency laparotomy. Abbreviated surgery was carried out because of progressing septic shock, and planned reoperation was carried out 2 days after the initial surgery. Histopathological examination revealed the perforation of pyometra with no evidence of malignancy. The patient was discharged on the 32nd postoperative day in stable condition. Conclusion We report a case of spontaneous perforation of pyometra with severe septic shock successfully treated by damage control surgery. Damage control surgery is a useful treatment option for hemodynamically unstable patients with diseases in the field of obstetrics and gynecology.
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Affiliation(s)
- Ryo Matsumoto
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Shunsuke Kuramoto
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Tomohiro Muronoi
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Kazuyuki Oka
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Yoshihide Shimojyo
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Akihiko Kidani
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Eiji Hira
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
| | - Hiroaki Watanabe
- Department of Acute Care Surgery Faculty of Medicine Shimane University Shimane Japan
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3
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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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4
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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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5
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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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6
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Ferhatoglu F, Filiz I. A rare phenomenon creating dilemma for the surgeon: Pneumoperitoneum after colonoscopy. SANAMED 2018. [DOI: 10.24125/sanamed.v13i2.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Pneumoperitoneum is free air existence in abdomen and usually caused by the perforation in gastrointestinal system. Peptic ulcer disease is the most common cause of perforation and pneumoperitoneum. The presence of free air in abdomen usually indicates emergency surgery. However, surgical approach is not required in some cases of pneumoperitoneum if there is no evidence of perforation and no sign of peritoneal irritation. Herein, we present an 82-year-old male patient who had pneumoperitoneum after colonoscopy and treated non-surgically.
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7
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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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8
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Yamana I, Noritomi T, Takeno S, Tatsuya H, Sato K, Shimaoka H, Yamaguchi R, Ishii F, Yamada T, Yamashita Y. Spontaneous Pneumoperitoneum due to Constipation. Case Rep Gastroenterol 2015; 9:361-5. [PMID: 26676063 PMCID: PMC4677735 DOI: 10.1159/000441999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a rare case of spontaneous pneumoperitoneum. An 82-year-old Japanese male patient was referred to our hospital because of constipation and abdominal pain. Abdominal computed tomography revealed a large amount of feces in the colon and rectum, and free air in the abdomen. Based on these findings, the patient was diagnosed with gastrointestinal perforation. Emergency exploratory laparotomy was performed. Neither perforation nor ischemic changes were recognized in the digestive tract. The patient's defecation was managed postoperatively until discharge on the 13th postoperative day. The authors assumed that free air, which was released after a mucosal injury due to the internal pressure caused by the presence of a large amount of feces in the colon and rectum, had penetrated the bowel wall through the bowel mucosa. We herein report the present case while also reviewing the pertinent literature.
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Affiliation(s)
- Ippei Yamana
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tomoaki Noritomi
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shinsuke Takeno
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hashimoto Tatsuya
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keisuke Sato
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hideki Shimaoka
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ryosuke Yamaguchi
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Fumiaki Ishii
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Teppei Yamada
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuichi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
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9
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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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10
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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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11
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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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12
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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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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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