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

Atsunori Nakao, Hisashi MIMURA, Kenji Fujisawa, Kazuhiko Ezawa, Takahiro Okamoto, Hiromi Iwagaki, Hiroshi Isozaki, Norihisa Takakura, Noriaki Tanaka
In: Surgery Today · 2000 · vol. 30(5) , pp. 454–457 · doi:10.1007/s005950050624 · PMID:10819486 · W2002569826
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-13 ⓘ

This case report details a perforated pyometra presenting as generalized peritonitis and pneumoperitoneum in an elderly woman, alongside a review of eight similar cases in Japanese literature.

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This paper reports a rare case of generalized peritonitis caused by a spontaneously ruptured pyometra in an 86-year-old woman, presenting with acute abdominal signs and CT evidence of pneumoperitoneum with an air-fluid level in a peritoneal cystic mass near the uterus. At laparotomy, the uterus was markedly enlarged with a necrotic perforation at the fundus, and the authors performed supravaginal hysterectomy and drainage; they also reviewed eight prior Japanese cases from 1977–1999. The authors note that while gastrointestinal perforation is the most common cause of pneumoperitoneum, other sources such as perforated pyometra should be considered, while acknowledging the evidence base is limited to case reports and a small literature review. Relevance to endometriosis: the paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

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 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. Similar content being viewed by others

References

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