{"paper_id":"eccfd2d6-0bce-4197-a969-b0463c5feccf","body_text":"Abstract\nWe 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 Japanese literature. The patient presented with muscle guarding and rebound tenderness. Computed tomography (CT) disclosed a cystic mass in the peritoneal cavity, in which an air-fluid level was noted. Pneumoperitoneum around the uterus due to gas production of anaerobic bacteria was noted on a CT. At laparotomy, the uterus was markedly enlarged with a necrotic area on the uterine 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 gastrointestinal tract. However, other possible causes, as seen in our patient, should also be taken into consideration. Although it is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.\nSimilar content being viewed by others\nReferences\nHenriksen E (1956) Pyometra associated with malignant lesions of the cervix and the uterus. Am J Obstet Gynecol 72:884–895\nHansen PT, Lindholt J (1985) Spontaneously perforated pyometra: a differential diagnosis in acute abdomen. Ann Chir Gynaecol 74:294–295\nKaneko Y, Doi M, Kaibara M (1994) Spontaneous perforation of pyometra: a case report. Asia Oceania J Obstet Gynecol 20:263–267\nMorris JG (1986) Energy-yielding metabolism. Anaerobic bacteria in habitats other than man. Butler & Tanner, Somerset, pp 2–4\nImachi M, Tanaka S, Ishikawa S, Matsuo K (1993) Spontaneous perforation of pyometra presenting as generalized peritonitis in a patient with cervical cancer. Gynecol Oncol 50:384–388\nBui A, Wilkinson S (1989) Generalized peritonitis due to spontaneous rupture of pyometra. Aust NZ J Obstet Gynecol 29:82–83\nHosking SW (1985) Spontaneous perforation of a pyometra presenting as generalized peritonitis. Postgrad Med J 61:645–646\nKimura H, Sodani H, Takamura H, Maeda K, Kanno M, Uogishi M, Kanno S, Suzuki N (1994) Spontaneously perforated pyometra presenting as diffuse peritonitis: report of a case. Surg Today 24:150–152\nRasmussen KL, Knudsen TA, Luckow A (1991) Perforation of a pyometra mimicking a perforated peptic ulcer. Arch Gynecol Obstet 248:211–212\nBostofte E, Legarth J (1981) Spontaneous perforation of pyometra with diffuse peritonitis. Acta Obstet Gynecol Scand 60:511–512\nGita R, Jain K, Vaid NB (1995) Spontaneous rupture of pyometra. Int J Gynecol Obstet 48:111–112\nSussman AM, Boyd CR, Christy RS, Rudolph R (1989) Pneumoperitoneum and an acute abdominal condition caused by spontaneous perforation of a pyometra in an elderly woman: a case report. Surgery 105:230–231\nAuthor information\nAuthors and Affiliations\nRights and permissions\nAbout this article\nCite this article\nNakao, A., Mimura, H., Fujisawa, K. et al. Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: Report of a case. Surg Today 30, 454–457 (2000). https://doi.org/10.1007/s005950050624\nReceived:\nAccepted:\nIssue date:\nDOI: https://doi.org/10.1007/s005950050624","source_license":"CC0","license_restricted":false}