A Case of Uterorectal Fistula due to Pyometra Improved by Conservative Therapy

Abstract

We report a very rare case of pyometral peritonitis due to uterine perforation an uterorectal fistula. A 61-year-old woman admitted for abdominal pain and fever was found in physical examination to present muscular de-fense in the lower abdomen. Abdominal pain resolved spontaneously, however, several hours after admission. Computed tomography showed an enlarged uterine cavity and an uterorectal fistula subsequently treated conservatively. Gastrografin enema study showed the fistula had shrunken, and computed tomography study showed air and fluid accumulation in the uterus. Trans-vaginal drainage of the uterus closed the uterorectal fistula and no pyometral or uterorectal fistula was observed thereafter indicating the effectiveness of proper drainage. Careful follow-up is necessary, however, because of possible pyometral recurrence.