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

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.

Download Full-text

Perforated pyometra is a misleading cause of acute abdomen in elderly women: case report and review of literature

Journal of Peritoneum (and other serosal surfaces) ◽

10.4081/joper.2017.30 ◽

2017 ◽

Author(s):

Matteo Nardi ◽

Paola Fugazzola ◽

Giacomo Crescentini ◽

Filippo Paratore ◽

Lucia Morganti ◽

...

Keyword(s):

Septic Shock ◽

Acute Abdomen ◽

Elderly Women ◽

Anterior Part ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Emergency Laparotomy ◽

Uterine Perforation ◽

Diffuse Peritonitis ◽

Contrast Enhanced Ct

Even if acute abdomen is associated with gastrointestinal (GI) perforation in more than 90% of cases, spontaneously perforated pyometra is a rare and misleading cause that gynecologists and general surgeons should suspect in elderly postmenopausal women. We report one case of diffuse peritonitis caused by spontaneous uterine perforation. A 94-year-old postmenopausal female was admitted to emergency department with signs of diffuse peritonitis and seven days history of abdominal pain. Abdominal contrast- enhanced CT-scan showed a large amount of ascites and a small amount of intraperitoneal free-air. One hour after the admission septic shock developed and emergency laparotomy was performed for suspected GI perforation. During laparotomy about 1500 mL of purulent, malodorous but not-fecaloid fluid was found in peritoneal cavity, without evidence of GI perforation. A 10 mm perforation on the anterior part of the uterine fundus was found. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Patients died on postoperative day four despite intensive care for multi-organ failure due to septic shock. The hysto-pathology examination showed absence of cancer. Pyometra perforation is a rare cause of acute abdomen with a not negligible mortality and it should be considered in the differential diagnosis of acute abdomen, especially in elderly patients. The aim of the study is to report our personal experience and a review of the literature of spontaneous perforation of pyometra in patients with no evidence of malignancy.

Download Full-text

Uterine Rupture with Massive Late Postpartum Hemorrhage due to Placenta Percreta Left Partially In Situ

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/906351 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Mehmet Coskun Salman ◽

Pinar Calis ◽

Ozgur Deren

Keyword(s):

Uterine Rupture ◽

Bladder Wall ◽

Placental Tissue ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Uterine Wall ◽

Placenta Percreta ◽

Emergency Laparotomy ◽

Life Threatening

Placental adhesive disorders involve the growth of placental tissue into or through the uterine wall. Among these disorders, placenta percreta is the rarest one. However, it may cause significant complications. This report aimed to report a neglected patient with placenta percreta who developed uterine rupture with life-threatening late postpartum intra-abdominal hemorrhage. On admission, the patient had acute abdomen with moderate abdominal distention and was subjected to emergency laparotomy. A full-thickness defect of the anterior uterine wall involving the hysterotomy site was seen. Placental tissues occupied both sides of the incision and posterior bladder wall was also invaded by placenta. Total abdominal hysterectomy with partial resection of the posterior bladder wall was performed.

Download Full-text

Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/idog/2006/60276 ◽

2006 ◽

Vol 2006 ◽

pp. 1-2 ◽

Cited By ~ 27

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.

Download Full-text

CAESAREAN SCAR PREGNANCY;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.05.1434 ◽

2013 ◽

Vol 20 (05) ◽

pp. 849-851

Author(s):

RAZIA SULTANA ◽

SAIF-UL- ISLAM ◽

NURJAHAN -

Keyword(s):

Uterine Rupture ◽

Operative Procedure ◽

Fibrous Tissue ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Massive Hemorrhage ◽

Emergency Laparotomy ◽

Caesarean Scar ◽

Caesarean Scar Pregnancy ◽

Profuse Hemorrhage

Caesarean Scar pregnancy (CSP) is a rare form of Ectopic pregnancy where the gestation sac is surrounded bymyometrium and the fibrous tissue of the scar from the previous caesarean section. It is often misdiagnosed as Molar pregnancy orInevitable Abortion and can be associated with massive hemorrhage and pervaginal bleeding leading to uterine rupture. Here we reporteda case of Caesarean scar pregnancy who presented with history of cesarean section and pervaginal bleeding. Dilatation and curettagewas planned but during the operative procedure there was profuse hemorrhage leading to hypovolumic shock which was managed byBlood and venesection then emergency laparotomy followed by Total Abdominal Hysterectomy done as life saving procedure,th postoperative period was uneventful and the patient was discharged on 10 postoperative day. Diagnosis is important as caesarean scarpregnancy is associated with life threatening complications such as uterine rupture, massive hemorrhage and the need for Hysterectomywith subsequent loss of fertility.

Download Full-text

Uterine torsion in non-gravid women: A case report and review of cases reported in the last 20 years

SAGE Open Medical Case Reports ◽

10.1177/2050313x211066649 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110666

Author(s):

Harunobu Matsumoto ◽

Yoko Aoyagi ◽

Taisuke Morita ◽

Kaei Nasu

Keyword(s):

Surgical Intervention ◽

Lower Abdominal Pain ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Uterine Leiomyomas ◽

Emergency Laparotomy ◽

Resonance Imaging ◽

Uterine Torsion ◽

Life Threatening ◽

Tomography Scan

Uterine torsion is defined as a rotation of >45° around the long axis of the uterus. Uterine torsion is an uncommon event but is even rarer in non-gravid women, with only 25 cases reported in the last 20 years. Here, we report a case of uterine torsion associated with multiple pedunculated subserosal uterine leiomyomas in an 83-year-old woman. She presented at the hospital with lower abdominal pain, and a computed tomography scan revealed multiple uterine leiomyomas with calcifications. Subsequent magnetic resonance imaging raised suspicion for torsion of pedunculated subserosal uterine leiomyomas. Emergency laparotomy was performed, and the patient was diagnosed with uterine torsion with multiple pedunculated subserosal uterine leiomyomas. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. The patient’s postoperative course was uneventful. Although difficult to diagnose due to its rarity, uterine torsion can be life-threatening and may cause infertility. Therefore, early diagnosis with imaging and surgical intervention are crucial to avoid serious complications.

Download Full-text

A positive urine pregnancy test with haemoperitoneum: misdiagnosed postpartum choriocarcinoma with uterine rupture mimicking ruptured ectopic pregnancy

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2021-0048 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Shakti Yeoh ◽

Soon-Leong Yong ◽

Pak-Inn Teoh ◽

Marcus Kang

Keyword(s):

Ectopic Pregnancy ◽

Uterine Rupture ◽

Histopathological Examination ◽

Wedge Resection ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Emergency Laparotomy ◽

Blood Product Transfusion ◽

Pregnancy Test ◽

Urine Pregnancy Test

Abstract Objectives Choriocarcinoma after a term pregnancy is rare and can be life-threatening, especially when it perforates the uterus, resulting in massive haemoperitoneum. As uterine rupture due to choriocarcinoma is uncommonly encountered in the clinical practice, its diagnosis is often missed or delayed. Case presentation We present a case of a 41-year-old para 4 + 1 who had acute abdomen and hypovolaemic shock secondary to haemoperitoneum at three months postpartum period. The urine pregnancy test was positive, and, therefore, a provisional diagnosis of a ruptured ectopic pregnancy was made. She was managed aggressively with fluids and blood product transfusion at the emergency department to achieve haemodynamic stability. Subsequently, she underwent an emergency laparotomy where intraoperatively noted a perforation at the left posterior uterine cornu with purplish tissue spillage. A wedge resection was performed, and the histopathological examination (HPE) was reported as atypical trophoblastic cells, in which choriocarcinoma could not be ruled out. The patient then underwent a total abdominal hysterectomy three weeks later. The final HPE confirmed the diagnosis of choriocarcinoma. Conclusions The clinical presentation of postpartum choriocarcinoma can be indistinguishable from a ruptured ectopic pregnancy. A high index of suspicion is crucial to allow early diagnosis.

Download Full-text

A Rare Case of Life-Threatening Invasive Mole

Journal of Karnali Academy of Health Sciences ◽

10.3126/jkahs.v1i2.24140 ◽

2018 ◽

Vol 1 (2) ◽

pp. 53-55

Author(s):

Rajiv Shah ◽

A.M. Samal

Keyword(s):

Acute Abdominal Pain ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Emergency Laparotomy ◽

Partial Mole ◽

Life Threatening ◽

Β Hcg ◽

Invasive Mole ◽

Uterine Fundus

A 23-year-old female with a known case of partial mole and under hCG follow up presented with acute abdominal pain and signs of hemoperitoneum. Emergency laparotomy revealed a molar pregnancy perforating through the uterine fundus, resulting in massive haemoperitoneum of 4 litres. Total abdominal hysterectomy was done. The serum β-hCG level regressed following hysterectomy.

Download Full-text

Anesthesia Management at Postpartum et causa Atonic Uteri Bleeding in P3A0H3 Post SCTP Outside Dr. Moewardi Hospital

Solo Journal of Anesthesi, Pain and Critical Care (SOJA) ◽

10.20961/soja.v1i1.49682 ◽

2021 ◽

Vol 1 (1) ◽

pp. 34

Author(s):

RTh Supraptomo ◽

Muhammad Ridho Aditya

Keyword(s):

General Anesthesia ◽

Postpartum Hemorrhage ◽

Hypovolemic Shock ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Emergency Laparotomy ◽

Excessive Bleeding ◽

Mortality And Morbidity ◽

Anesthesia Management ◽

Intraoperative Management

Postpartum hemorrhage remains the leading cause of maternal mortality and morbidity worldwide, happens more in developing countries with an estimated mortality rate of 140,000 per year or one maternal death every four minutesTo understand anesthesia management at postpartum et causa atonic uteri bleeding outside Dr. Moewardi hospitalIn this case reported 25 years old patient was admitted to the emergency room at Dr. Moewardi Hospital Surakarta, on the 28/11/2019 at 15.30 WIB, sent by Waras Hospital Wiris Boyolali. On examination found the patient in a state of weakness, apathy awareness and blood pressure 90/60, heart rate 130, respiration rate 22, conjunctival anemic and palpable contractions of soft uterine contractions. The patient's condition is in accordance with the manifestation of grade III blood loss. The anesthesiology diagnosis is a 25-year-old woman with Postpartum hemorrhage et causa Atonic Bleeding of Uterine on P3A0H3 post SCTP Outside Dr. Moewardi Hospital + Hypovolemic Shock pro Emergency Laparotomy until Total Abdominal Hysterectomy with Physical Status ASA IVE Plan with RSI general anesthesia Control.Intraoperative Management of anesthesia uses RSI's general anesthesia technique to control hemodynamics and uses anesthesia drugs that do not worsen the patient's condition. At the time of surgery, we did the transfusion because there was a significant amount of bleeding during the procedure and was categorized as Class IV bleeding.Anesthesia care of patients with postpartum hemorrhage extends from the antenatal period to the postpartum period. Optimal postpartum hemorrhage management occurs when nurses, obstetricians and anesthesiologists recognize early the potential for excessive bleeding and trigger a 'major obstetric hemorrhage protocol' that describes specific tasks for each team player and the algorithm that must be followed according to etiology, circumstances and time during labor.

Download Full-text

Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

Case Reports in Obstetrics and Gynecology ◽

10.1155/2014/738568 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 4

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.

Download Full-text