Spontaneous Rupture of Pyometra in a Nonpregnant Young Woman
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Introduction
Known as a rare condition, pyometra is considered as the collection of pus in the uterine cavity. Blockage of the cervical canal secondary to benign or malignant cervical or endometrial lesions and outcomes of their treatments, cervicitis, postvaginal surgery, puerperal infection, and congenital cervical anomaly are the main cause of pyometra. Moreover another rare case is spontaneous perforation of pyometra and subsequent diffuse peritonitis with an incidence of about 0.01%–0.05% . There is a high association between pyometra on one hand and malignancies, risk of perforation, and high mortality rate in a way that clinicians get aware of this disease, especially in postmenopaused women presenting with acute abdomen. A woman was reported who has been treated under a clinical diagnosis of diffuse peritonitis caused by spontaneously perforated pyometra without malignancy.

Case Presentation
A 40-year-old woman presented with vaginal bleeding to Gynecology Service. Bleeding had started two days earlier and was getting severe. Bleeding had happened after lifting a heavy box and was associated with abdominal pain. The pain was generalized and was associated with vomiting. She had no past medical history. She was using contraception and also she was a pill user. She had 2 children, both delivered via cesarean. She did not have any evidence of sexually transmitted disease. On presentation, her blood pressure was 90/60, she was tachycardic at 96, and her body temperature was 37.2. On examination uterus was about 8–10 weeks, it was tender in palpation, and cervix had a normal appearance with a heavy bleeding. Her abdomen was generally tender....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337346/
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