A case of spontaneous perforation of pyometra with generalized peritonitis

Abstract

A 76-year-old woman was admitted to the department of orthopedic surgery of our hospital, and she underwent an operation for cervical spondylosis. She frequently used nonsteroidal anti inflammatory drugs after the operation. She was prescribed prednisolone for rheumatoid arthritis. After 6 weeks of the orthopedic surgery, she had fever. The fever persisted inspite of treatment with antibiotics. Three weeks later, she had severe lower abdominal pain of sudden onset. Laboratory studies showed a white blood cell count of 25,600/mm³ and c-reactive protein level (CRP) of 8.1 mg/dl. Abdominal CT scan revealed the presence of free air and fluid in the abdominal cavity. We suspected gastrointestinal perforation and performed emergency laparotomy. A large amount of watery and foul-smelling pus was found in the abdominal cavity. The gastrointestinal tract appeared normal. The pus exuded from a 5-mm perforation in the fundus of the uterus. We performed peritoneal lavage and drainage to remove the pus. In addition the uterine pus was removed by transperitoneal drainage, thereby eliminating the need for hysterectomy. The patient recovered and was moved to the department of orthopedic surgery for rehabilitation.
Peritoneal lavage and drainage with transperitoneal drainage of the uterine pus are effective, when the general status of patient is extremely poor or the patient has complications.