TWO CASES OF GENERALIZED PERITONITIS CAUSED BY PERFORATED PYOMETRA

This paper describes 2 cases of generalized peritonitis caused by perforated pyometra. Seventy-eight (case 1) and 92-year-old (case 1) women were admitted to the hospital because of abdominal pain. In case l a uterus-like tumor was palpated in the lower abdomen, but the definite diagnosis could not be attained. Under a suspicion of gastrointestinal perforation, operation was carried out. In case 2 imaging methods revealed a swollen uterus, and digital examination comfirmed a soft tumor with remarkable tenderness in the Douglas pouch. From these findings a diagnosis of generalized peritonitis due to perforated pyometra was made. Emergency operation was performed. Operative findings in both cases included about l cm-sized perforation in the fundus of the uterus gushing pus. Pathohistologically there was no malignant findings and remarkable inflammation in the endometrium and muscular layer was noted. In Japan 22 cases of perforated pyometra including this case have been seen in the literature. Only 3 cases of them were correctly diagnosed by preoperative examination. When we encounter acute abdomen in aged women, this disease should be entertained as a possible. diagnosis.