A case of panperitonitis caused by perforation of a pyometra with sigmoid colon cancer

Abstract

An 89-year-old woman visited a hospital because of abdominal pain and was pointed out free air on an abdominal CT scan. Since she had been pointed out bloody stools and an elevated CEA level at that hospital, she was referred to the emergency center in our hospital with a suspicion of gastrointestinal perforation due to malignant neoplasm of the lower gastrointestinal tract. When she was first seen, an abdominal CT scan showed intraabdominal free air and ascites and perforative peritonitis was diagnosed. She was in a shock state so that laparotomy under general anesthesia was considered impossible. She was admitted to our hospital for the purpose of conservative therapy. With intensive care, her general condition gradually became stable. An abdominal CT scan on the 18th hospital day disclosed a pyometra, and transvaginal drainage was performed. Lower gastrointestinal endoscopy on the 42nd hospital day revealed sigmoid colon cancer. Hartmann operation was performed on the 64th hospital day, when no perforated sites were seen around the sigmoid colon cancer but perforation was present in the fundus of uterus. Hysterectomy was thus performed as well.
Perforation of a pyometra is often misdiagnosed as gastrointestinal perforation, and it must be kept in mind as a probable differential diagnosis of causative disorders for perforative peritonitis in aged women.