A Case of Perforative Pyometra with a Uterine Myoma that was Difficult to Diagnose

Abstract

An 81-year-old woman was referred to our hospital with a fever and abdominal defence. Abdominal CT revealed free air around the sigmoid colon and fluid mainly in the Douglas pouch, and thickening of the enteric wall. We made a diagnosis of sigmoid colon perforation with generalized peritonitis, so an emergency operation was performed. Intraoperatively, an expanded intestine and a large quantity of purulent ascites were observed. There was no perforation of the small intestine or colon. Purulent fluid had pooled in the Douglas pouch, and a perforation was found at the dorsal side of the corpus uteri. We made a diagnosis of perforative pyometra, and enforced a subtotal hysterectomy with drainage. After surgery, acute cure for sepsis and DIC was performed. In this case, diagnosis was difficult because of a uterine myoma.