Two cases of pyometra presenting with acute abdomen

Abstract

Two cases of pyometra are described.
Case 1 : An 86-year-old woman was bedridden due to a right femoral fracture. She developed fever and lower abdominal pain. Abdominal CT revealed free air and ascites in the upper abdomen. Under a diagnosis of acute peritonitis caused by an intestinal perforation, a laparotomy was performed. It was found that the anterior wall of the uterine body was perforated and that pus flowed from the uterus. There were no abnormalities found anywhere along the total length of the intestine. Therefore, a generalized peritonitis due to a perforation of a pyometra was diagnosed. A simple hysterectomy and bilateral salpingooophorectomy were performed.
Case 2 : A 63-year-old woman was bedridden due to sequelae of a brain hemorrhage. She developed abdominal pain and went into shock. Abdominal CT revealed a collection of fluid in the uterus. Under a diagnosis of pyometra, transvaginal drainage was performed. With an aging population the diagnosis of pyometra may increase in Japan. This disease should be kept in mind as a possible cause of acute abdomen in older females.