Abstract
A 94-year-old woman was brought to our hospital complaining of continuous severe abdominal pain and showing signs of peritonitis. CT scan revealed ascites at the surface of the liver and paracolic gutter. Free air in the lower abdomen was also present. A fluid accumulation was apparent in the uterine cavity and dotted images of gas were observed in the uterine wall through multiplanar reconstruction (MPR) images. Moreover, coronal images showed free air at the apex of the uterus, and this was visually shown to be contiguous with free air in the uterine wall. Thus, it appeared that the wall had become detached at the uterine fundus, and perforation at this site was strongly suspected. Following these findings, the patient was diagnosed with peritonitis due to pyometra and uterine rupture. Since a large volume of purulent ascites and the apex of the uterine body with perforation were present by emergency laparotomy, peritoneal lavage and a total hysterectomy including the right adnexa were performed. While it is relatively rare to observe acute celiopathy due to perforated pyometra in elderly women, the preoperative diagnosis of this condition was considered to be the result of careful interpretation of multiplanar CT images.
