Abstract
A 56-year-old woman was admitted to our hospital because of acute abdominal pain and fever. She had unresectable cervical cancer and was under chemo-radiation therapy. On admission, white blood cell count was 18,400/mm3 and CRP was 17.3 mg/dl revealing an increased inflammatory response. Abdominal plain X-ray examination revealed no free air. However, a pelvic computed tomography (CT) scan revealed the presence of free air and visualized the swollen uterus with comparatively homogeneous fluid and gas. We suspected gastrointestinal perforation and performed an emergency laparotomy. The perforation was found not in the intestine, but rather in the fundus of the uterus, and cloudy ascites were noted throughout the entire abdominal cavity. We performed primary suture to the perforation site and overlapped the greater omentum, peritoneal lavage and drainage.
In cases of uterus cancer suspected of diffuse peritonitis, surgeons should consider the possibility of perforated pyometra.
