2016 Volume 36 Issue 6 Pages 1131-1134
We report a case of acute perforated peritonitis secondary to rupture of a pyometra associated with a rectovaginal fistula. A 72-year-old woman who had been under follow-up for a rectovaginal fistula with pyometra caused by insertion of a pessary was admitted to our hospital with the complaint of abdominal pain. Physical examination revealed tenderness and muscle guarding in the lower abdomen. Transvaginal US examination revealed a fluid-filled uterus. CT examination showed ascites and a distended fluid-filled uterus. In addition, free air was detected in the abdominal and uterine cavities. We diagnosed the patient as a case of acute perforated peritonitis and performed emergency laparotomy. At laparotomy, a perforation was found in the anterior wall of the uterine body. Therefore, total abdominal hysterectomy, bilateral salpingo-oophorectomy and resection of the rectovaginal fistula were performed. In elderly female patients, peritonitis caused by rupture of a pyometra should be considered in the differential diagnosis of acute abdomen.
