Abstract
A 77-year-old woman reporting lower abdominal pain was found in computed tomography (CT) to have a large amount of ascites and free air in the pelvic cavity. Perforation of the digestive tract was suspected preoperatively, necessitating emergency laparotomy. There ware no abnormal findings in the alimentary tract. The uterus had a perforation 5 mm in diameter in the fundus, from which purulent fluid flowed. Based on a diagnosis of uterine cancer, we conducted total hysterectomy with bilateral salpingooophorectomy and intraperitoneal drainage. The definitive diagnosis was pyometra by histological examination. There was no evidence of malignancy. The culture of purulent fluid in the uterus showed nonhemolytic streptococcus. Although a ruptured pyometra presenting as pneumoperitoneum is very rare, physicians should consider the presence of perforated pyometra, especially when elderly women report acute abdominal pain.
