Diffuse peritonitis caused by spontaneous perforation of pyometra: A case report and literature review

Abstract BackgroundUterine perforation is commonly caused by iatrogenic injuries, tumours, and traumas. Uterine perforation resulting from infection is less common, and such perforation rarely causes abdominal empyema and diffuse peritonitis. Infectious complications such as shock and multiple organ dysfunction are extremely dangerous and even life threatening. Correct early diagnosis and appropriate treatment can reduce the mortality of pyometra.Case presentationA 62-year-old woman presented to our hospital with persistent abdominal pain for 5 hours. The patient had undergone hysteroscopy six months ago, and a cystic space-occupying lesion of the uterus was found one month ago. Perfect the various examinations, consider the patient as acute diffuse peritonitis Perforation of the digestive tract? Uterine cavity infection. In the emergency department, laparoscopic exploration was performed. During the operation, it was diagnosed as pyometra and perforation of the right uterine fundus. Then, combined with a gynecologist, a hysterectomy with double appendages was performed. The operation went smoothly. The patient had paralytic intestinal obstruction after the operation. After active symptomatic treatment The patient recovered well and was discharged. Postoperative pathology results were as follows: 1. Moderately differentiated squamous cell carcinoma of the cervix (non-keratinizing type); 2. Metastatic squamous cell carcinoma of the right ovary; 3. Perforation of the fundus of the uterus, pyometra, and extensive purulent inflammation of the muscle wall .ConclusionsUterine perforation is a rare cause of acute abdomen. Clinicians often don't know enough about this, and they are prone to misdiagnosis and missed diagnosis. For elderly women with abdominal pain and peritonitis, the possibility of empyema perforation should be considered during diagnosis and treatment, and the examination should be improved to avoid misdiagnosis, because correct early diagnosis and appropriate treatment can reduce the mortality of empyema.