Nakao A, Mimura H, Fujisawa K, Ezawa K, Okamoto T, Iwagaki H, Isozaki H, Takakura N, Tanaka N
Department of Surgery, Kurashiki Kosai Hospital, Okayama, Japan.
Surg Today. 2000;30(5):454-7. doi: 10.1007/s005950050624.
We report a rare case of generalized peritonitis due to a ruptured pyometra in an 86-year-old woman, and also conduct a review of the previous Japanese literature. The patient presented with muscle guarding and rebound tenderness. Computed tomography (CT) disclosed a cystic mass in the peritoneal cavity, in which an air-fluid level was noted. Pneumoperitoneum around the uterus due to gas production of anaerobic bacteria was noted on a CT. At laparotomy, the uterus was markedly enlarged with a necrotic area on the uterine fundus, which was found to be perforated. A supravaginal hysterectomy and drainage were performed. We found only eight cases of a ruptured pyometra presenting as pneumoperitoneum in the Japanese literature between 1977 and 1999. The most common cause of pneumoperitoneum is a perforation of the gastrointestinal tract. However, other possible causes, as seen in our patient, should also be taken into consideration. Although it is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.
我们报告了一例86岁女性因子宫积脓破裂导致弥漫性腹膜炎的罕见病例，并对既往日本文献进行了回顾。患者表现为肌紧张和反跳痛。计算机断层扫描（CT）显示腹腔内有一个囊性肿块，其中可见气液平面。CT显示子宫周围因厌氧菌产气导致气腹。剖腹手术时，子宫明显增大，子宫底部有坏死区域，发现已穿孔。行阴道上子宫切除术及引流术。我们在1977年至1999年的日本文献中仅发现8例子宫积脓破裂表现为气腹的病例。气腹最常见的原因是胃肠道穿孔。然而，正如我们患者所见，其他可能的原因也应予以考虑。因此，当老年女性出现急性腹痛时，虽然罕见，但也应考虑子宫积脓穿孔的情况。
