SPONTANEOUS PERFORATED PYOMETRA PRESENTING AS PNEUMOPERITONEUM

Background: Spontaneous perforated pyometra presenting as pneumoperito neum is extremely rare. Case report: An 80-year old Japanese female wi th spontaneous perforating pyometra presenting as pneumoperitoneum is reported. The patient came to our institute with severe abdominal pain . Routine abdominal examination showed muscular defense, and plain che st roentgenograms revealed infradiaphragmatic free gas. Subsequent com puted tomography also demonstrated pneumoperitoneum. Laparotomy was pe rformed on the basis of a tentative diagnosis of perforation of the ga strointestinal tract but revealed a perforated pyometra. A simple hyst erectomy was performed, The histological diagnosis of the surgical spe cimen was acute endometritis without neoplasm. The present report is t he third case of spontaneous perforated pyometra with pneumoperitoneum to date. Conclusion: Although uterine disease presenting as pneumoper itoneum is rare in elderly patients with an acute abdomen? the possibi lity of a perforated pyometra should be considered in the differential diagnosis.