A Case of Perforative Pyometra with Intra-Pelvic Abscess

Abstract

A 90-year-old woman hospitalized for compressed fracture of the second lumbar vertebra developed fever and lower abdominal pain. We diagnosed the patient as having pyometra based on the findings of abdominal CT, and transvaginal drainage was performed by a gynecologist. However, the symptoms persisted. Moreover, the patient developed signs of peritoneal irritation and a repeat CT revealed intra-pelvic abscess; therefore, we performed emergency surgery. On laparotomy, there was no evidence of perforation in the intestine. We found inflammatory adhesion of the uterus to the rectum and bladder and abscess formation on the pelvic floor. Based on diagnosis of perforative pyometra with intra-pelvic abscess, supra-vaginal amputation of the uterus and abdominal drainage were performed. Pyometra is more common in elderly women and has demonstrated an upward trend with the aging of society. Most cases are successfully treated by transvaginal drainage, but fewer spontaneously perforate as a result of occlusion of the cervical canal by malignant tumor, surgery, radiotherapy, or senile cervicitis. Therefore, careful follow-up was considered to be important.