Abstract
The patient was a 76-year-old female with a chief complaint of sudden abdominal pain. She was subsequently transferred to another hospital due to acute abdomen. She was suspected to have superior mesenteric artery embolism based on the findings of enhanced abdominal computed tomography (CT). Reexamination of the CT scans showed ascites and enlargement of the uterus with wall thickening. The patient was transferred to our center due to suspected perforative pyometra. Under a diagnosis of perforative pyometra, abdominal total hysterectomy was performed, which revealed an intrauterine device (IUD) in the uterine according to the pathological findings. The IUD was believed to have caused the patient’s perforative pyometra. Her general condition improved, and she was moved to the Gynecology Department on day 9 after the surgery. Differentiating perforative pyometra from lower intestinal perforation is sometimes difficult. Focusing on the observed low-density area which was associated with the gas image in the uterine cavity based on the findings of a CT scan, it is therefore important to make an accurate and definitive diagnosis preoperatively in the case of this disease. Furthermore, it should be carefully taken into consideration that an IUD can cause a perforated pyometra.
