Spontaneous perforation of pyometra in a cervical cancer patient: a case report and literature review

Abstract

Pyometra is an uncommon condition with an incidence of less than 1% in gynaecologic patients. Spontaneous rupture of pyometra in cervical cancer presenting as generalized peritonitis is very rare. Only four cases have been described in the English literature to the best of our knowledge and from a PubMed search. The index case is an elderly postmenopausal female who was diagnosed with cervical cancer, started on radiotherapy and presented with features of generalized peritonitis. Contrast-enhanced CT revealed uterine perforation at the fundus with multiple abdominal and pelvic collections. A brief review of all the cases of ruptured pyometra in cervical cancer in the literature and a discussion of the role of imaging is presented.

Figure 1

Contrast-enhanced axial CT images showing dilated endometrial cavity with site of the breach at uterine fundus (arrow). Pelvic collections (*) are seen with the abdominal/mesenteric extension and resultant intra-abdominal collections (*).

Figure 2

Contrast-enhanced coronal and sagittal reformatted CT image depicting dilated endometrial cavity with site and size of the breach at uterine fundus (arrow). Multiple pelvic and intra-abdominal collections (*) are seen. The larger pelvic collection is seen in continuation with the ruptured uterus.