Generalized peritonitis with pneumoperitoneum caused by the spontaneous perforation of pyometra without malignancy: Report of a case

Spontaneous perforation is a very rare complication of pyometra. We report herein the case of an 88-year-old woman who presented with muscular rigidit y and free air on abdominal X-ray films. Perforation of the gastrointestina l tract was diagnosed preoperatively, and an emergency laparotomy was perfo rmed. A total hysterectomy with bilateral salpingo-oophorectomy was carried out under the diagnosis of generalized peritonitis caused by the spontaneo us perforation of pyometra. The culture of purulent fluid from the abdomina l cavity showed only Escherichia coli, with no anaerobic bacteria. Histolog ical examination revealed pyometra with necrosis of the endometrium and no evidence of malignancy. The patient was discharged on postoperative day 68 without any major complications. Pyometra is an unusual cause of peritoniti s, but it must be considered as a possible diagnosis in elderly women prese nting with an acute abdomen. Following this case report, we discuss the pro blems associated with establishing a correct preoperative diagnosis of gene ralized peritonitis caused by the spontaneous perforation of pyometra.