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Case Report
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| Perforated pyometra presenting as a pelvic abscess: A case report |
| Afrasyab Khan1, Jagdish Prasad2 |
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1House Surgeon, Whakatane Hospital. Whakatane, New Zealand.
2Consultant General Surgery, Whakatane Hospital, Whakatane, New Zealand. |
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doi:10.5348/ijcri-2012-02-89-CR-3
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Address correspondence to: Dr. Afrasyab Khan House Surgeon Whakatane Hospital Whakatane 3158 New Zealand Fax: 073060969 Email: afrasyabkhan@gmail.com |
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| How to cite this article: |
| Khan A, Prasad J. Perforated pyometra presenting as a pelvic abscess: A case report. International Journal of Case Reports and Images 2012;3(2):10-14. |
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Abstract
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Introduction:
Pyometra - the accumulation of purulent material inside the uterus - can be asymptomatic in 50% of cases. A perforated pyometra usually presents with an acute abdomen at the outset and it is unusual for it to present as a pelvic abscess.
Case Report: We present the case of a 57-years-old lady, who presented with increasing epigastric pain. She was hypotensive with epigastric tenderness. She had an elevated white count and elevated liver enzymes. Imaging did not reveal the etiology of her condition. She started to have peritoneal signs on hospital day nine and was taken to the operating theatre for exploratory laparotomy. A pelvic abscess was found that was communicating with a perforated pyometra. Hysterectomy and bilateral salpingo-oophorectomy was performed. No evidence of malignancy was found on histo pathologic examination. The patient had post operative ileus and was on parenteral nutrition. She soon recovered and was discharged home. Conclusion: A perforated pyometra is usually seen in post menopausal women and presents as an acute abdomen. It is associated with blockage of the endocervical canal. The patient in this case had a pelvic abscess that had walled off the perforation. The patient had symptoms for a while as overt peritonitis had not developed. No malignancy was identified. A high index of suspicion is needed to diagnose a perforated pyometra in postmenopausal patients presenting as an acute abdomen or a pelvic abscess. It may not be associated with malignancy and presentation may be overtly acute or insidious. | |
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Key Words:
Pyometra, Abscess, Acute abdomen, Peritonitis
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Author Contributions:
Afrasyab Khan - Substantial contributions to conception and design, acquisition, analysis and interpretation of data, Drafting the article, revising it critically for important intellectual content, Final approval of the version to be published Jagdish Prasad - Substantial contributions to conception and design; and interpretation of data, Drafting the article, revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of Submission. |
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Source of support:
None |
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Conflict of interest:
The authors declare no conflict of interest. |
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Copyright:
© Afrasyab Khan et al. 2012; This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see http://www.ijcasereportsandimages.com/copyright-policy.php for more information.) |
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