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This case series reports on five elderly patients (all >70 years) who underwent emergency surgery for perforated pyometra presenting with diffuse peritonitis between 1985 and 1993. The authors describe sudden severe abdominal pain in all cases, with one patient rapidly progressing to profound shock, and note that CT, ultrasonography, and simple abdominal X-ray correctly detected perforated pyometra in only two cases. All patients received hysterectomy with bilateral salpingo-oophorectomy; histology showed pyometra with inflammation and destruction of the endometrium and myometrium without evidence of malignancy, and four patients recovered uneventfully while one died of sepsis. The paper emphasizes the rarity of the condition and the lack of typical symptoms before perforation as a limitation for preoperative diagnosis. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.
Abstract
Pyometra is a relatively rare disease to form an abscess in the uterus when drainage of discharge from the uterus is inhibited at somewhere. Besides, perforated pyometra causing peritonitis is very uncommon. From 1985 to 1993, emergency operation was undertaken for 5 cases of perforated pyometra presenting with diffuse peritonitis. They were all more than 70 years old. Severe anbdominal pain occurred suddenly in all cases and one case fell in profound shock status soon after that symptom. Diagnosis was tried to make using CT, ultrasonography and simple abdominal X-ray examination, but only 2 cases were detected as the perforated pyometra by those diagnostic aids. Histerectomy with bilateral salpingoopharectomy was carried out in cases. Histological examination revealed pyometra with inflammation and destruction of the endmetrium and myometorium without any evidence of malignancy. Postoperative course was uneventful in 4 cases. However, one case could not recover from profound shock status and died of sepsis. This disease will increasingly appear from now on when we are seeing the aged society. Any typical symptoms could not be detected before perforation of pyometra, accordingly rigorous and careful examinations are necessary for aged female patient complaining of severe abdominal pain of unknown origin.
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FIVE CASES OF PERFORATED PYOMETRA PRESENTING WITH DIFFUSE PERITONITIS
1995 Volume 56 Issue 9 Pages 1955-1958
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Abstract
Pyometra is a relatively rare disease to form an abscess in the uterus when drainage of discharge from the uterus is inhibited at somewhere. Besides, perforated pyometra causing peritonitis is very uncommon. From 1985 to 1993, emergency operation was undertaken for 5 cases of perforated pyometra presenting with diffuse peritonitis. They were all more than 70 years old.
Severe anbdominal pain occurred suddenly in all cases and one case fell in profound shock status soon after that symptom.
Diagnosis was tried to make using CT, ultrasonography and simple abdominal X-ray examination, but only 2 cases were detected as the perforated pyometra by those diagnostic aids.
Histerectomy with bilateral salpingoopharectomy was carried out in cases.
Histological examination revealed pyometra with inflammation and destruction of the endmetrium and myometorium without any evidence of malignancy.
Postoperative course was uneventful in 4 cases. However, one case could not recover from profound shock status and died of sepsis.
This disease will increasingly appear from now on when we are seeing the aged society. Any typical symptoms could not be detected before perforation of pyometra, accordingly rigorous and careful examinations are necessary for aged female patient complaining of severe abdominal pain of unknown origin.
Severe anbdominal pain occurred suddenly in all cases and one case fell in profound shock status soon after that symptom.
Diagnosis was tried to make using CT, ultrasonography and simple abdominal X-ray examination, but only 2 cases were detected as the perforated pyometra by those diagnostic aids.
Histerectomy with bilateral salpingoopharectomy was carried out in cases.
Histological examination revealed pyometra with inflammation and destruction of the endmetrium and myometorium without any evidence of malignancy.
Postoperative course was uneventful in 4 cases. However, one case could not recover from profound shock status and died of sepsis.
This disease will increasingly appear from now on when we are seeing the aged society. Any typical symptoms could not be detected before perforation of pyometra, accordingly rigorous and careful examinations are necessary for aged female patient complaining of severe abdominal pain of unknown origin.
© Japan Surgical Association
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