Abstract
We present herein on the case of an 80 year old woman who was transported to our institution by ambulance after being diagnosed as having strangulated right inguinal hernia, and who then underwent emergency surgery (laparoscopy-assisted hernioplasty). The hernia included the small intestine and greater omentum, which were subsequently partially resected under the suspicion of necrosis. Post-operative blood sampling revealed persistent inflammatory findings, and on CT performed on day 7 a Douglas' abscess was suspected, which was treated with continued administration of antibiotics. However on day 13 sudden abdominal pain appeared, which led to the diagnosis of panperitonitis and emergency surgery was performed. After the incision into the abdomen was made, contaminated ascites was observed. The examination of the pelvic cavity revealed pyometra perforation induced panperitonitis. The patient had worn a ring pessary for many years to treat a uterine prolapse, which is believed to have caused the pyometra. Peritoneal drainage and a simple hysterectomy were performed. In patients who wear a ring pessary for a long period of time as contraception or to prevent uterine prolapse, it is important to note that the ring may cause pyometra and pyometra perforation.
