子宮筋腫膿瘍破裂による汎発性腹膜炎に対して腹腔鏡下子宮筋腫核出術を施行した１例

抄録

  A pyomyoma, or suppurative leiomyoma, characterized by infarction- or infection-induced purulent changes in a leiomyoma is extremely rare; only approximately 50 cases have been reported in the available literature since 1945. We report a case of peritonitis due to a ruptured pyomyoma, successfully treated with emergency laparoscopic surgery.

  A 64-year-old postmenopausal gravida 0, para 0, with a history of uterine leiomyoma presented to our emergency department with fever and abdominal pain. On physical examination, she was febrile with mild nonspecific abdominal distention without rebound tenderness. Pelvic examination revealed an enlarged tender uterus. Laboratory investigations showed a significant increase in inflammatory markers, and computed tomography revealed an enlarged pelvic mass with calcification, a thick-walled cystic mass (12 cm), intestinal dilatation, and ascites. We performed emergency laparoscopy for suspected peritonitis secondary to a suppurative leiomyoma. Exploratory laparoscopy revealed massive purulent ascites and a ruptured pyomyoma. We performed laparoscopic myomectomy and lavage. The patient showed an uneventful recovery and was discharged 15 days postoperatively.

  Although laparoscopic management of peritonitis is challenging, this approach offers the advantages of direct observation and prevention of surgical site infection. In conclusion, immediate surgical intervention is warranted in patients with peritonitis secondary to a suspected pyomyoma. We consider laparoscopic approach is useful not only for diagnosis but also for surgical treatment.