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Muacevic A, Adler JR, Potdar J, Mohammad S. Massive Pyometra Due to Senile Endometritis in a Postmenopausal Woman: A Rare Entity. Cureus 2022; 14:e32775. [PMID: 36686128 PMCID: PMC9854204 DOI: 10.7759/cureus.32775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
An 83-year-old postmenopausal female P5L5 (all full-term normal deliveries) presented with complaints of foul-smelling purulent discharge per vagina for 15 days associated with pain in abdomen. A midline mass was palpable per abdomen in the suprapubic region corresponding to 16 weeks size gravid uterus, which was soft to firm in consistency. On examination per vaginum, the atrophied cervix was found flush with the vagina and purulent discharge was seen draining through the cervix. Blood reports showed raised total leucocyte count with granulocyte predominance. Abdominal ultrasonography revealed a uterine cavity filled with echogenic contents, with no abdominal cavity collection. The patient was started on IV antibiotics and planned for dilatation and curettage. On histopathology acute on chronic senile endometritis was found with no evidence of malignant cells. Tuberculosis gene testing was found to be negative. We conclude that the senile endometritis leading to cervical stenosis as seen during dilatation and curettage had led to the pyometra and no evidence of malignancy was found.
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2
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Lee S, Lee J, Hong N. Perforated pyometra misdiagnosed as generalized peritonitis caused by an ileal perforation. Clin Exp Emerg Med 2022; 8:340-341. [PMID: 35000363 PMCID: PMC8743681 DOI: 10.15441/ceem.20.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Seokyoun Lee
- Department of Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Junhee Lee
- Department of Emergency Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Nurhee Hong
- Department of Radiology, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
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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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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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5
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Kim KH. Pneumoperitoneum Caused by the Spontaneous Perforation of a Pyometra in an 80-Year-Old Woman: A Case Report. JOURNAL OF ACUTE CARE SURGERY 2020. [DOI: 10.17479/jacs.2020.10.2.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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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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7
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Abstract
RATIONALE The incidence of spontaneous perforations in pyometra occurs rarely, only 0.01% to 0.5% in gynecological patients, with high mortality and morbidity. The clinical manifestation of perforated uterine pus is similar to that of gastrointestinal perforation, but the gynecological symptoms are not so obvious, which makes preoperative diagnosis difficult. Here, we report a rare case of peritonitis with laparotomy of pyometra. PATIENT CONCERNS An acute abdominal pain and purulent vaginal discharge developed in a 72-year-old woman who underwent an emergency laparotomy because of signs of diffuse peritonitis and in a state of shock. DIAGNOSES We made a diagnosis of spontaneous perforation of pyometra. INTERVENTIONS At laparotomy, about 1000 mL of pus with the source of uterine was found in the abdominal cavity, while gastrointestinal tract was intact and a crevasse with a diameter of 1.5 cm on posterior uterine wall was obvious. A total abdominal hysterectomy and a bilateral salphingo oophorectomy were performed. OUTCOMES The patient got discharged on 34th postoperative hospitalization day with only 1 complication of wound healing. Histopathological study revealed uterine purulent inflammation, with no evidence of malignancy. LESSONS Ultrasonography is the first and most sensitive examination for the evaluation of pyometra, but has limited role in the diagnosis of perforated pyometra. Additional diagnostic radiographic evaluation use for acute abdomen is total abdomen computed tomography scan and magnetic resonance imaging techniques of female pelvis.
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8
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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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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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10
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Spontaneous Rupture of Pyometra Causing Peritonitis in Elderly Female Diagnosed on Dynamic Transvaginal Ultrasound. Case Rep Radiol 2016; 2016:1738521. [PMID: 26989549 PMCID: PMC4775801 DOI: 10.1155/2016/1738521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 01/20/2016] [Indexed: 11/17/2022] Open
Abstract
Pyometra is collection of pus within the uterine cavity and is usually associated with underlying gynaecological malignancy or other benign causes. Spontaneous rupture of pyometra is a rare complication. We report a case of a 65-year-old female who presented with acute abdomen and was diagnosed with a ruptured uterus secondary to pyometra and consequent peritonitis on dynamic transvaginal sonography (TVS) which was later confirmed on contrast enhanced computed tomography (CECT). An emergency laparotomy was performed and about 800 cc of pus was drained from the peritoneal cavity. A rent was found in the anterior uterine wall and hence hysterectomy was performed. Histopathology revealed mixed inflammatory cell infiltrate with no evidence of malignancy. There are only 31 cases of ruptured pyometra reported till date, most of which were definitively diagnosed only on laparotomy. In only two of these cases the preoperative diagnosis was made on CECT. We report this case, as the correct and definitive diagnosis was made preoperatively on dynamic TVS. To our knowledge, this is the first case report revealing spontaneous ruptured pyometra being diagnosed preoperatively on dynamic TVS. This report is aimed at giving emphasis on the use of simple dynamic TVS for accurate diagnosis of rare spontaneous ruptured pyometra causing peritonitis.
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11
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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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12
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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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13
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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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14
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Choudhary D, Mohanty D, Garg PK. Pyometra: a rare cause of acute peritonitis. Surg Infect (Larchmt) 2014; 15:354-5. [PMID: 24796754 DOI: 10.1089/sur.2013.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Deepti Choudhary
- 1 Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital , University of Delhi, India
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15
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Spontaneous rupture of pyometra. Case Rep Obstet Gynecol 2013; 2013:298383. [PMID: 24024054 PMCID: PMC3760260 DOI: 10.1155/2013/298383] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 07/14/2013] [Indexed: 11/18/2022] Open
Abstract
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. In most cases, a correct and definite diagnosis can be made only by laparotomy. We report two cases of diffuse peritonitis caused by spontaneous perforated pyometra. The first case is a 78-year-old woman with abdominal pain for which laparotomy was performed because of suspected incarcerated hernia. The second case is a 61-year-old woman with abdominal pain for which laparotomy was performed because of symptoms of peritonitis. At laparotomy of both cases, 1 liter of pus with the source of uterine was found in the abdominal cavity. The ruptured uterine is also detected. More investigations revealed no malignancy as the reason of the pyometra.
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16
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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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17
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Ou YC, Lan KC, Lin H, Tsai CC, ChangChien CC. Clinical characteristics of perforated pyometra and impending perforation: specific issues in gynecological emergency. J Obstet Gynaecol Res 2010; 36:661-6. [PMID: 20598053 DOI: 10.1111/j.1447-0756.2010.01184.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the clinical characteristics of pyometra and the differences between perforated pyometra and early-drained pyometra in order to prevent morbidity. MATERIAL AND METHODS Retrospective study of 14 patients diagnosed between 1998 and 2008 with early-drainage pyometra and six patients with perforated pyometra were included. In addition, a review of the literature yielded another 30 perforated pyometra cases for comparison. RESULTS Of 20 women with pyometra, the main presented symptoms at admission were abdominal pain (80%), fever (45%) and vaginal discharge (25%). The majority of organisms isolated were Bacteroides fragilis (seven cases), Streptococcus species (six cases) and Escherichia coli (five cases). Of the 36 cases with spontaneous uterine perforation to date, 35 cases (97%) had abdominal pain, 11 cases (31%) had fever, and 10 cases (27%) had vomiting. Hypoalbuminemia was found in seven patients (five cases in the perforation group and two cases in the drainage group). CONCLUSION Early diagnosis of pyometra before perforation can avoid surgical exploration and decrease morbidity and mortality. Perforated pyometra should be considered as a differential diagnosis in women with pneumoperitoneum and fever. Hypoalbuminemia should be considered as a predisposing factor for pyometra perforation.
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Affiliation(s)
- Yu-Che Ou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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18
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Ambler DR, Diamond MP, Malone J. Haemophilus influenzae abscess: inclusion in the differential diagnosis of a large pelvic mass? J Minim Invasive Gynecol 2010; 17:104-6. [PMID: 20129341 DOI: 10.1016/j.jmig.2009.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 09/04/2009] [Accepted: 09/14/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND This report describes an unusual first case in which an abscess containing Haemophilus influenzae incorporates the entire uterine cavity without overt signs of infection. CASE A 39-year-old woman presented with right lower quadrant abdominal pain and a large abdominal pelvic mass. Evaluation with computed tomography and ultrasonography showed a 20- x 14- x 10-cm cystic mass arising from the uterus. Tumor markers were negative. The patient underwent a total abdominal hysterectomy. Intraoperative findings included a 20-cm intramyometrial uterine abscess, completely replacing the uterine cavity. The abscess was densely adhered to the sigmoid colon. The mass was ruptured during the surgical procedure when mobilizing it off the colon, and cultures were obtained. Microbiologic culture illustrated H. influenzae. Pathologic diagnosis confirmed an intramyometrial abscess, originating from the wall of the uterus occupying the entire uterine cavity, lined with granulation tissue, foamy macrophages, and chronic inflammation. CONCLUSION Intramyometrial abscesses can masquerade as degenerating fibroids and, even with microorganisms, can exist without overt signs or symptoms of an active infection.
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Affiliation(s)
- D R Ambler
- Division of Gynecology, Department of Obstetrics and Gynecology, Wayne State University, Detroit Medical Center, Detroit, MI, USA.
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19
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Vyas S, Kumar A, Prakash M, Kapoor R, Kumar P, Khandelwal N. Spontaneous perforation of pyometra in a cervical cancer patient: a case report and literature review. Cancer Imaging 2009; 9:12-4. [PMID: 19419914 PMCID: PMC2681288 DOI: 10.1102/1470-7330.2009.0002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pyometra is an uncommon condition with an incidence of less than 1% in gynaecologic patients. Spontaneous rupture of pyometra in cervical cancer presenting as generalized peritonitis is very rare. Only four cases have been described in the English literature to the best of our knowledge and from a PubMed search. The index case is an elderly postmenopausal female who was diagnosed with cervical cancer, started on radiotherapy and presented with features of generalized peritonitis. Contrast-enhanced CT revealed uterine perforation at the fundus with multiple abdominal and pelvic collections. A brief review of all the cases of ruptured pyometra in cervical cancer in the literature and a discussion of the role of imaging is presented.
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Affiliation(s)
- Sameer Vyas
- Postgraduate Institute of Medical Education and Research PGIMER, Chandigarh, India.
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Affiliation(s)
- D Geggie
- A&E Department, Warrington General Hospital, Lovely Lane, Warrington, Cheshire WA13 OPS, UK.
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