Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: Report of a case

We report a rare case of generalized peritonitis due to a ruptured pyometra in an 86-year-old woman, and also conduct a review of the previous Japanes e literature. The patient presented with muscle guarding and rebound tender ness. Computed tomography (CT) disclosed a cystic mass in the peritoneal ca vity, in which an air-fluid level was noted, Pneumoperitoneum around the ut erus due to gas production of anaerobic bacteria was noted on a CT. At lapa rotomy, the uterus was markedly enlarged with a necrotic area on the uterin e fundus, which was found to be perforated, A supravaginal hysterectomy and drainage were performed. We found only eight cases of a ruptured pyometra presenting as pneumoperitoneum in the Japanese literature between 1977 and 1999. The most common cause of pneumoperitoneum is a perforation of the gas trointestinal tract, However, other possible causes, as seen in our patient , should also be taken into consideration, Although it is rare, a perforate d pyometra should therefore also be considered when elderly women present w ith acute abdominal pain.