Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum

Abstract

Pneumoperitoneum is usually associated with gastrointestinal perforation or following surgical and endoscopic procedures. We report a rare case of spontaneously perforated pyometra presenting with generalised peritonitis and pneumoperitoneum. Perforation of the uterus is also unusual and often associated with the presence of an intrauterine device, a gravid uterus or malignancy. Our case illustrates the importance of clinical knowledge of acute and neoplastic gynaecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynaecology colleagues is essential as operative intervention is often required.

Figure 1

Axial computed tomography showing free intraperitoneal air (A) in the upper abdomen, suggestive of gastrointestinal perforation

Figure 2

Axial computed tomography showing a fluid filled uterus with a perforation and free air in the anterior wall (A). Leiomyomata can also be seen on the posterior wall (B).

Figure 3

Histological examination demonstrating endometrial inflammatory exudates (A) and granulation tissue (B). Haematoxylin and eosin stain (100x magnification).

Figure 4

Histological examination demonstrating inflamed myometrium (A) and peritonitis (B). Haematoxylin and eosin stain (40x magnification).