Abstract
An 81-year-old woman was brought into the emergency clinic in our hospital by ambulance because of clouding of consciousness late in October 2006. When she was first seen, she regained consciousness and had no abnormal neurological findings. However, a fist-sized tumor was palpable in the left lower quadrant of abdomen. Digital examination revealed a tumor and tenderness in the left direction of the anterior wall of the rectum. An abdominal CT scan showed thickening of the intestinal wall at the recto-sigmoid portion, and obscure border between the affected intestine and the uterine and the left adnexa. Air fluid level was noted in the lumen of the uterus. Barium enema showed an irregular stricture at the recto-sigmoid portion. From these findings, the most likely diagnosis was rectal carcinoma with pyometra and then we performed low anterior resection of rectum with hysterectomy and left salpingooophorectomy. The rectal tumor had invaded the uterus to form a fistula and it was pathologically confirmed to have invaded the lumen of the uterus.
It is etiologically considered that uterus invasion of rectal carcinoma formed the rectouterine fistula, with resultant pyometra.
