Browne Ikennah L
Department of Surgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
J Surg Case Rep. 2022 Aug 30;2022(8):rjac388. doi: 10.1093/jscr/rjac388. eCollection 2022 Aug.
Spontaneous perforation of pyometra is a rare event associated with significant morbidity and mortality when diffuse peritonitis is present. While malignant lesions of the cervical tract are the most common cause of pyometra, several benign conditions can contribute to this diagnosis. Traditionally hysterectomy has been the surgical approach of choice for this clinical entity; however, in the setting of septic shock, temporizing techniques may offer the opportunity to stabilize patients and complete a thorough work up before committing to definitive resection. This report explores a case of septic shock secondary to spontaneous perforation of pyometra that was definitively managed with peritoneal lavage and wide drainage. Intraoperative hysteroscopy and uterine biopsy were performed, and no malignancy was identified on final pathology. Intraoperative hysteroscopy along with peritoneal lavage and wide drainage may reduce the morbidity and mortality associated with sepsis from spontaneous perforation of pyometra and potentially avoid unnecessary hysterectomy.
积脓自发性穿孔是一种罕见事件，当出现弥漫性腹膜炎时，会伴有显著的发病率和死亡率。虽然宫颈管恶性病变是积脓最常见的原因，但一些良性情况也可导致此诊断。传统上，子宫切除术一直是针对这一临床病症的首选手术方法；然而，在感染性休克的情况下，临时性技术可能为稳定患者病情并在进行确定性切除之前完成全面检查提供机会。本报告探讨了一例因积脓自发性穿孔继发感染性休克的病例，该病例通过腹膜灌洗和广泛引流得到了明确治疗。术中进行了宫腔镜检查和子宫活检，最终病理检查未发现恶性病变。术中宫腔镜检查以及腹膜灌洗和广泛引流可能会降低积脓自发性穿孔所致败血症的发病率和死亡率，并有可能避免不必要的子宫切除术。
