scholarly journals Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Toshihiro Kitai ◽  
Kentaro Okuno ◽  
Hiromi Ugaki ◽  
Yoshiko Komoto ◽  
Satoshi Fujimi ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Uterine Cavity ◽  
Severe Infection ◽  
Wound Dehiscence ◽  
Multiple Organ ◽  
Uterine Perforation ◽  
Diffuse Peritonitis ◽  
Spontaneous Perforation ◽  
Diffuse Abdominal Pain ◽  
Generalized Peritonitis

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.

scholarly journals Generalized Peritonitis Secondary to Spontaneous Perforation of Pyometra in a 63-Year-Old Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Ahmed Abu-Zaid ◽  
Osama AlOmar ◽  
Ahmed Nazer ◽  
Ayman Azzam ◽  
Zainab Abudan ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Abdominal Cavity ◽  
Uneventful Recovery ◽  
Diffuse Peritonitis ◽  
Spontaneous Perforation ◽  
High Grade Fever ◽  
Diffuse Abdominal Pain ◽  
Generalized Peritonitis ◽  
Plain Chest Radiograph ◽  
Free Air

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 grewStreptococcus constellatus. Patient had an uneventful recovery. Moreover, a brief literature review on pyometra is presented.

scholarly journals Diffuse peritonitis caused by spontaneous perforation of pyometra: A case report and literature review

2021 ◽  
Author(s):  
Hao Xu ◽  
Yifan Zhuang ◽  
Caiming Wang ◽  
Yongjie Zhou ◽  
Haofei Chen ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Abdominal Pain ◽  
Early Diagnosis ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Uterine Cavity ◽  
Uterine Perforation ◽  
Diffuse Peritonitis ◽  
Appropriate Treatment ◽  
The Right

Abstract BackgroundUterine perforation is commonly caused by iatrogenic injuries, tumours, and traumas. Uterine perforation resulting from infection is less common, and such perforation rarely causes abdominal empyema and diffuse peritonitis. Infectious complications such as shock and multiple organ dysfunction are extremely dangerous and even life threatening. Correct early diagnosis and appropriate treatment can reduce the mortality of pyometra.Case presentationA 62-year-old woman presented to our hospital with persistent abdominal pain for 5 hours. The patient had undergone hysteroscopy six months ago, and a cystic space-occupying lesion of the uterus was found one month ago. Perfect the various examinations, consider the patient as acute diffuse peritonitis Perforation of the digestive tract? Uterine cavity infection. In the emergency department, laparoscopic exploration was performed. During the operation, it was diagnosed as pyometra and perforation of the right uterine fundus. Then, combined with a gynecologist, a hysterectomy with double appendages was performed. The operation went smoothly. The patient had paralytic intestinal obstruction after the operation. After active symptomatic treatment The patient recovered well and was discharged. Postoperative pathology results were as follows: 1. Moderately differentiated squamous cell carcinoma of the cervix (non-keratinizing type); 2. Metastatic squamous cell carcinoma of the right ovary; 3. Perforation of the fundus of the uterus, pyometra, and extensive purulent inflammation of the muscle wall .ConclusionsUterine perforation is a rare cause of acute abdomen. Clinicians often don't know enough about this, and they are prone to misdiagnosis and missed diagnosis. For elderly women with abdominal pain and peritonitis, the possibility of empyema perforation should be considered during diagnosis and treatment, and the examination should be improved to avoid misdiagnosis, because correct early diagnosis and appropriate treatment can reduce the mortality of empyema.

scholarly journals Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

2006 ◽  
Vol 2006 ◽  
pp. 1-2 ◽  
Author(s):  
Loabat Geranpayeh ◽  
Mohsen Fadaei-Araghi ◽  
Behnam Shakiba
Keyword(s):  
Abdominal Pain ◽  
Alimentary Tract ◽  
Elderly Women ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Perforation ◽  
Diffuse Peritonitis ◽  
Cervical Canal ◽  
Surgical Specimen ◽  
Generalized Peritonitis

Spontaneous perforation of the uterus is rare, its incidence being about0.01%–0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63-year-old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, liver, or gallbladder. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.

scholarly journals Medical Management of Pyometra in the Delayed Postoperative Period

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Natalie A. Vukmer ◽  
Heather Urrego ◽  
A. Mitch Dizon
Keyword(s):  
Abdominal Pain ◽  
Uterine Cavity ◽  
Rare Condition ◽  
Operative Management ◽  
Uterine Perforation ◽  
Normal Female ◽  
Diffuse Abdominal Pain ◽  
Life Threatening ◽  
Timely Fashion ◽  
Hospital Stays

Pyometra is a rare condition in which purulent material becomes entrapped within the uterine cavity. If unrecognized in a timely fashion, life-threatening complications can arise. The following is a case report of a 50-year-old female who presented to the emergency department with abdominal pain and heavy vaginal bleeding. She was diagnosed with a pyometra based on imaging and treated conservatively with antibiotics. The patient ultimately had an uncomplicated hysterectomy with resolution of normal female pelvic anatomy prior to surgery. Pyometra should be considered when women present with diffuse abdominal pain or peritonitis. As demonstrated in this report, early detection and conservative management may help prevent serious complications such as uterine perforation, lead to shorter hospital stays, and result in safer operative management.

scholarly journals Spontaneous Perforation of Pyometra Presenting as Acute Abdomen and Pneumoperitoneum Mimicking Those of Gastrointestinal Origin

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Takahiro Yamada ◽  
Nanako Ando ◽  
Naoshi Shibata ◽  
Motomu Suitou ◽  
Hiroshi Takagi ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Multiple Organ ◽  
General Surgeon ◽  
Emergency Laparotomy ◽  
Diffuse Peritonitis ◽  
Spontaneous Perforation ◽  
Gynecological Diseases ◽  
Postmenopausal Female

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.

scholarly journals Intra-abdominal pressure monitoring in postoperative period in patients with diffuse peritonitis

2015 ◽  
Vol 96 (2) ◽  
pp. 214-219 ◽  
Author(s):  
E K Salakhov ◽  
K K Salakhov
Keyword(s):  
Organ Failure ◽  
Organ Dysfunction ◽  
Dynamic Assessment ◽  
Clinical Manifestations ◽  
Multiple Organ ◽  
Abdominal Pressure ◽  
Diffuse Peritonitis ◽  
Pressure Monitoring ◽  
Systemic Complications ◽  
Functional Changes

Epidemiology, etiology, pathologic and morphologic changes associated with increased intra-abdominal pressure are described. The most common ways of its measuring and monitoring are presented. Intra-abdominal pressure is increased by more than 15 mm Hg in patients with diffuse peritonitis. Increased intra-abdominal pressure is associated with the disease severity: the higher the intra-abdominal pressure, the more severe is the disease. If intra-abdominal pressure is increased over 20 mm Hg, treatment strategy depends on the signs of organ failure. In the absence of organ failure, intra-abdominal pressure should be monitored every 4 hours as long as the patient is in critical condition. Intra-abdominal pressure monitoring in case of peritonitis must be attributed to the mandatory manipulation, as pressure changes precede the clinical manifestations of intra-abdominal complications. Measurement of intra-abdominal pressure allows to detect the early signs of multiple organ failure, which is essential for the correction of systemic complications in pancreatogenic peritonitis. In this case, monitoring of intra-abdominal pressure in diffuse postoperative peritonitis should be considered only as a screening test for assessing of the organ dysfunction severity, as the development of multiple organ dysfunction syndrome involves complex pathophysiological mechanisms. Predictions that are more accurate can be made using such integrated indicators as APACHE II (Acute Physiology And Chronic Health Evaluation scale, which is used for assessing various acute and chronic diseases), SAPS (Simplified Acute Physiology Score - a simplified scale for acute functional changes assessment), SOFA (Sepsis-related Organ Failure Assessments Score - scale for dynamic assessment of organ failure in sepsis), MPI (Mannheim Peritonitis Index) scales.

scholarly journals A Rare Case of Intrauterine Adhesion Caused by Intrauterine Fallopian Tube Incarceration

2021 ◽  
pp. 64-67
Author(s):  
Yiran Liu ◽  
Yugang Chi
Keyword(s):  
Fallopian Tube ◽  
Rare Case ◽  
Early Recognition ◽  
Uterine Cavity ◽  
Uterine Perforation ◽  
Secondary Infertility ◽  
False Passage ◽  
Intrauterine Adhesion ◽  
Tubal Lumen ◽  
The Right

Hysteroscopy is widely used for the detection and treatment of intrauterine adhesion. Such technique, however, sometimes has limitations and even second damages. We report a rare case of severe intrauterine adhesion caused by uterine perforation with a fallopian tube incarceration. A 24-year-old woman underwent severe intrauterine adhesion and secondary infertility caused by fallopian tube incaceration into the uterine cavity after postpartum curettage. First hysteroscopy created a false passage through the previous uterine perforation, entered into the cavity of incarcerated fallopian tube, and led to iatrogenic hydrosalpinx. Secondary hysteroscopy combined with laparoscopy revealed a connection between the right tubal lumen and the uterine cavity by the false passage, released the adhesion, and reconstructed the uterine cavity. Early recognition of uterine perforation or tissue incarcerarion is significant in preventing further damage.

scholarly journals WOUND DEHISCENCE;

2018 ◽  
Vol 25 (08) ◽  
pp. 1143-1146
Author(s):  
Ammrah Tahir ◽  
Muhammad Sajid Hameed Ansari ◽  
Abdul Waheed Khan
Keyword(s):  
Controlled Trial ◽  
Wound Dehiscence ◽  
Midline Laparotomy ◽  
Mass Closure ◽  
Generalized Peritonitis ◽  
Study Results ◽  
Group A ◽  
Continuous Mass ◽  
Group B ◽  
Laparotomy Incision

Objectives: To compare the continuous and interrupted closure in term offrequency of wound dehiscence in emergency midline laparotomy incision. Study Design:Randomized controlled trial. Setting: Surgical Unit-I, Allied Hospital Faisalabad. Period: From15th March 2014 to 15th November 2014. Material and Methods: Two hundred patients werediagnosed clinically by taking thorough history and examinations were included. Fascial layerof wound of the patients sampled for group A was closed with interrupted mass closure withprolene no.1 whereas in group B was closed by continuous mass closure with prolene no1. All included patients were kept nothing by mouth. Resuscitation was done with, ringerslactate and blood transfusion if needed until adequate urine output (0.5 ml/kg/hr). Base lineinvestigations were done. After resuscitation and giving preoperative antibiotics, patients wereexplored through mid-line incision. Obvious source of contamination was dealt with accordingly.Variables wound were examined daily for any sign of dehiscence. Temperature pulse wasmeasured daily along with surgical site examination for any kind of discharge, stitches cutthrough and gut visibility through wound. In case of no complication patient was discharged ontenth postoperative day, which was the end point of study. Results: There were 61 (61%) malesand 39 (39%) females in group A, while in group B, 63 (63%) males and 37 (37%) females withmean ages of patients were 39.77+10.16 and 38.61+9.75 respectively. The wound dehiscencewere found 7 (7%) in Group-A and 18(18%) in Group-B while remaining 93 (93%) in Group-Aand 82 (82%) in Group-B had no morbidity statistically (p<0.01). Conclusion: It is concludedthat wound dehiscence is significantly higher in continuous closure as compare to interruptedclosure for emergency midline laparotomy incision for generalized peritonitis.

scholarly journals Pneumoperitoneum Secondary to Spontaneously Perforated Pyometra

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Benjamin A. Raymond ◽  
Christopher Esper
Keyword(s):  
Postmenopausal Women ◽  
Acute Abdomen ◽  
Surgical Intervention ◽  
English Literature ◽  
Uterine Cavity ◽  
Premenopausal Women ◽  
Diffuse Peritonitis ◽  
Intrauterine Devices ◽  
Purulent Fluid

Pyometra, by definition, is a collection of purulent fluid within the uterine cavity. Incidence has been estimated to range from 0.1% to 0.5%. Typically, this is linked to postmenopausal women; however, it has been linked to premenopausal women with concordant use of intrauterine devices. Based on our knowledge, there have been less than 50 recorded cases reported in the English literature regarding perforation of pyometra resulting in acute abdomen and fewer than 25 resulting in pneumoperitoneum. We report a patient who was evaluated for diffuse peritonitis caused by perforated pyometra who was successfully treated with surgical intervention.

scholarly journals Spontaneous Perforation of Pyometra

2006 ◽  
Vol 2006 ◽  
pp. 1-3 ◽  
Author(s):  
Begüm Yildizhan ◽  
Esra Uyar ◽  
Alper Şişmanoğlu ◽  
Gülfem Güllüoğlu ◽  
Zehra N. Kavak
Keyword(s):  
Genital Tract ◽  
English Literature ◽  
Rare Complication ◽  
Uterine Cavity ◽  
Benign Tumors ◽  
Spontaneous Perforation ◽  
Endometrial Polyps ◽  
Common Cause ◽  
Spontaneous Uterine Rupture ◽  
Gynecologic Patients

Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is0.01–0.5%in gynecologic patients; however, as far as elderly patients are concerned, its incidence is13.6%[3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy). Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture.

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