A Case of Panperitonitis with Free Air Caused by Pyometra

Abstract

An 86-year-old woman with chronic rheumatoid arthritis was transferred to the Kawaguchi Municipal Medical Center due to acute abdomen with free air. The patient was suspected to have panperitonitis caused by diverticular perforation of the sigmoid colon based on the findings of contrast-enhanced abdominal computed tomography (CT). The CT findings showed massive ascites and free air with thickened sigmoid colon wall. Emergent laparotomy revealed perforation at the uterine fundus with accumulated pus. However, no perforated sites were present of the sigmoid colon. Subsequently, abdominal partial hysterectomy and bilateral salpingo-oophorectomy were performed. The patient received intensive care after surgery because of septic shock. The patientʼs general condition eventually became stable. Generally, it is rare frequency for pyometra to progress peritonitis caused by perforation. In addition, free air is commonly associated with gastrointestinal perforation. Such situations sometimes can induce delayed diagnosis and fatal conditions. Therefore, we need to consider perforative pyometra as a differential diagnosis in aged women with free air, especially in the case of long-term steroid user.