The objective of this study was to report our cases of spontaneous pyometra perforation and to do a literature review for the same. Total 62 articles were reviewed from the year 2000 to 2023. After detailed screening, a total of 45 cases were selected for review. Analysis was done in terms of age, symptoms, preoperative diagnosis and treatment mainly. The mean age of presentation for SPP is 73 years. Most common presenting symptom is abdominal pain associated with vomiting. The most common preoperative diagnosis for them is hollow viscus perforation i.e., almost 49%. Most common site of rupture has been found to be fundus (71%). Hysterectomy remains the mainstay of treatment. An elderly lady presenting in emergency room with features of frank pyoperitoneum and septic shock, differential of pyometra perforation should always be kept in mind. An early intervention from gynecology department in these patients carries a good prognosis.
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References
1.
SawabeM, TakuboK, EsakiY, et al.Spontaneous uterine perforation as a serious complication of pyometra in elderly females. Aust NZ J Obst Gynaeco, 1995; 35(1):87–91.
HansenPT, LindholtJ. Spontaneously perforated pyometra. A differential diagnosis in acute abdomen. Ann Chir Gynaecol, 1985; 74:294–295.
4.
NakaoA, MimuraH, FujisawaK, et al.Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: Report of a case. Surg Today, 2000; 30(5):454–457.
5.
IwaseF, ShimizuH, KoikeH, YasutomiT. Spontaneously perforated pyometra presenting as diffuse peritonitis in older females at nursing homes. J Am Geriatr Soc, 2001; 49(1):95–96.
6.
YildizhanB, UyarE, SişmanoğluA, et al.Spontaneous perforation of pyometra. Infect Dis Obstet Gynecol, 2006:26786.
7.
TsaiMS, WuMH. Images in clinical medicine. Pneumoperitoneum due to spontaneously perforated pyometra. N Engl J Med, 2006; 354(21):e23.
8.
GeranpayehL, Fadaei-AraghiM, ShakibaB. Spontaneous uterine perforation due to pyometra presenting as acute abdomen. Infect Dis Obstet Gynecol, 2006:60276.
9.
NuamahNM, HamalogluE, KonanA. Spontaneous uterine perforation due to pyometra presenting as acute abdomen. Int J Gynaecol Obstet, 2006; 92(2):145–146.
10.
ChanKS, TanCK, MakCW, et al.Computed tomography features of spontaneously perforated pyometra: A case report. Acta Radiol, 2006; 47(2):226–227.
11.
IzumiJ, HiranoH, YoshiokaH, TakisawaJ. Computed tomography findings of spontaneous perforation of pyometra. Jpn J Radiol, 2010; 28(3):247–249.
12.
SahooSP, DoraAK, HarikaM, KumarKR. Spontaneous uterine perforation due to pyometra presenting as acute abdomen. Indian J Surg, 2011; 73(5):370–371.
13.
StunellH, HouD, FinlaysonS, HarrisAC. Spontaneous perforation of pyometra due to acute necrotising endometritis. J Obstet Gynaecol, 2011; 31(7):673–674.
14.
LimSF, LeeSL, ChiowAK, et al.Rare cause of acute surgical abdomen with free intraperitoneal air: Spontaneous perforated pyometra. A report of 2 cases. Am J Case Rep, 2012; 13:55–57.
15.
KutukMS, OzgunMT, TasM, UludagS. Spontaneous uterine perforation due to pyometra. J Obstet Gynaecol, 2013; 33(3):322–323.
16.
ShapeyIM, NasserT, DickensP, et al.Spontaneously perforated pyometra: An unusual cause of acute abdomen and pneumoperitoneum. Ann R Coll Surg Engl, 2012; 94(8):e246–8.
17.
PatilV, PatilLS, ShiragurS, IchalakaranjiR. Spontaneous rupture of pyometra—a rare cause of peritonitis in elderly female. J Clin Diagn Res, 2013; 7(8):1735–1736.
18.
Abu-ZaidA, AlomarO, NazerA, et al.Generalized peritonitis secondary to spontaneous perforation of pyometra in a 63-year-old patient. Case Rep Obstet Gynecol, 2013; 2013:1–4.
19.
MallahF, EftekharT, Naghavi-BehzadM. Spontaneous rupture of pyometra. Case Rep Obstet Gynecol, 2013; 2013:1–2.
20.
YousefiZ, SharifiN, MorshedyM. Spontaneous uterine perforation caused by pyometra: A case report. Iran Red Crescent Med J, 2014; 16(9):e14491.
21.
KitaiT, OkunoK, UgakiH, et al.Spontaneous uterine perforation of pyometra presenting as acute abdomen. Case Rep Obstet Gynecol, 2014; 2014:1–6.
ChauhanA, SharmaMM, BanerjeeJK. Spontaneous perforation of pyometra: A rare cause of diffuse peritonitis. Med J Armed Forces India, 2015; 71(2):192–193.
24.
YamadaT, AndoN, ShibataN, et al.Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin. Case Rep Surg, 2015; 2015:1–3.
25.
SinghA, MundhraR, AgarwalT, RadhakrishnanG. Spontaneous rupture of pyometra manifesting as an acute abdomen: A case report. Trop Doct, 2015; 45(3):200–203.
26.
YinWB, WeiYH, LiuGW, et al.Spontaneous perforation of pyometra presenting as acute abdomen: A rare condition with considerable mortality. Am J Emerg Med, 2016; 34(4):761.e3-5–761.e5.
UnoK, TanoS, YoshiharaM, et al.A case report and literature review of spontaneous perforation of pyometra. J Emerg Med, 2016; 50(5):e231-6–e236.
29.
DesaiAY, PalandeB, DhabolkarS, PaiVD. Perforative peritonitis-gastrointestinal tract may not always be the source. Indian J Surg, 2017; 79(2):160–162.
30.
RaymondBA, EsperC. Pneumoperitoneum secondary to spontaneously perforated pyometra. Case Rep Obstet Gynecol, 2017; 2017:1–3.
31.
BalasŞ, YılmazKB, YıldırımSA, et al.Spontaneous perforation of pyometra: A rare cause of acute abdomen and sepsis. Turk J Surg, 2018; 34(4):342–345.
32.
HuangY, TianQ. Postmenopausal spontaneous rupture of pyometra: A case report. Medicine (Baltimore), 2018; 97(52):e13659.
33.
YazawaH, ImaizumiK. Generalized peritonitis secondary to spontaneously perforated pyometra in elderly women: Two cases with different clinical courses and surgical approaches and review of the literature. Fukushima J Med Sci, 2020; 66(1):53–59.
34.
TakamatsuJ, KangJ, FukuharaA, et al.Damage control management of perforating pyometra presenting with septic shock after the return of spontaneous circulation. Case Rep Med, 2020; 2020:8545232.
35.
MatsumotoR, KuramotoS, MuronoiT, et al.Damage control surgery for spontaneous perforation of pyometra with septic shock: A case report. Acute Med Surg, 2021; 8(1):e657.
36.
BrowneIL. Spontaneous perforation of pyometra-is hysterectomy required in the emergent setting? A case report and literature review. J Surg Case Rep, 2022; 2022(8):rjac388.
LiXL, LinJ. Spontaneous uterine perforation of pyometra leads to acute abdominal pain and septic shock: A case report. World J Emerg Med, 2022; 13(6):504–506.
39.
OuYC, LanKC, LinH, et al.Clinical characteristics of perforated pyometra and impending perforation: Specific issues in gynecological emergency. J of Obstet and Gynaecol, 2010; 36(3):661–666.
40.
IkedaM, TakahashiT, KurachiH. Spontaneous perforation of pyometra: A report of seven cases and review of the literature. Gynecol Obstet Invest, 2013; 75(4):243–249.
