Postmenopausal spontaneous rupture of pyometra
The incidence of spontaneous perforations in pyometra occurs rarely, only 0.01% to 0.5% in gynecological patients, with high mortality and morbidity.

The clinical manifestation of perforated uterine pus is similar to that of gastrointestinal perforation, but the gynecological symptoms are not so obvious, which makes preoperative diagnosis difficult. Published in the journal Medicine, the authors report a rare case of peritonitis with laparotomy of pyometra.

An acute abdominal pain and purulent vaginal discharge developed in a 72-year-old woman who underwent an emergency laparotomy because of signs of diffuse peritonitis and in a state of shock. A diagnosis of spontaneous perforation of pyometra was made.

At laparotomy, about 1000 mL of pus with the source of uterine was found in the abdominal cavity, while gastrointestinal tract was intact and a crevasse with a diameter of 1.5 cm on posterior uterine wall was obvious. A total abdominal hysterectomy and a bilateral salphingo oophorectomy were performed.

The patient got discharged on 34th postoperative hospitalization day with only 1 complication of wound healing. Histopathological study revealed uterine purulent inflammation, with no evidence of malignancy.

Lessons:-
- Ultrasonography is the first and most sensitive examination for the evaluation of pyometra, but has limited role in the diagnosis of perforated pyometra.

- Additional diagnostic radiographic evaluation use for acute abdomen is total abdomen computed tomography scan and magnetic resonance imaging techniques of female pelvis.

Read in detail here: https://pxmd.co/sa42I
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Dr. S●●●●●v S●●●●●1
Dr. S●●●●●v S●●●●●1 Obstetrics and Gynaecology
Possibility of pyometra and it' s rarest complication should be borne in mind in the senile age group. The most frequent diagnostic tool i. e. usg though frequently chosen as the first diagnostic modality I may not be wrong if I am given the opportunity to do a simple per speculum examination after doing a per vaginal examination where some purulant vaginal discharge is invariably noted and a simple gentle cervical dilatation would prove to be of immense diagnostic and therapeutic help after which usg may be done. And the place of colpotomy and drain as a gold standard should not be forgotten in most situations in place of laparotomy and drain. In the era of diagnostic laparoscopy this particular exception and clinical entity should not be forgotten as this is not the corporate style of management and as basic Gynaecologists we should feel proud of our domain i. e. clinical application of our knowledge and experience.... Read more
Jan 3, 2019Like