A Laparoscopic Hysterorrhaphy for a Perforated Pyometra: Report of A Case

Abstract

A pyometra rarely causes uterine perforation. An 83-year-old woman was admitted to our hospital with abdominal pain and fever. There was defense in her right hypochondrium. Abdominal contrast CT confirmed ascites around the liver and along the right paracolic gutter, and an enlarged gallbladder was noted with a partially non-enhancing gallbladder wall. Although acute cholecystitis was suspected, at the same time, the swelling of the uterus, the thickening of the wall and intraluminal fluid accumulation were recognized. With the possibility of perforation of the uterus also in mind, we performed a laparoscopic examination. At laparoscopy, the gallbladder was intact without any inflammation. The uterus was enlarged, and was found to have a small perforation, 5mm in diameter, in the uterine fundus, with identification of purulent material exuding from the uterine cavity, which was compatible with the diagnosis of a perforated pyometra. We performed laparoscopic hysterorrhaphy, peritoneal irrigation, and drainage. Although the patient developed septic shock postoperatively, she recovered well after intensive care and was discharged on the 24th postoperative day. We were able to treat her without a great deal of stress thanks to the use of the examination laparoscope. Laparoscopic surgery was useful in both the diagnosis and treatment of this perforated pyometra.