Mohd Hanapiah Fadhila, Ismail Zul Khairul Azwadi, Puteh Othman, Aziz Mohd Ezane
Radiology, Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, MYS.
Cureus. 2024 Jan 29;16(1):e53154. doi: 10.7759/cureus.53154. eCollection 2024 Jan.
Uterine rupture in the setting of pyometra is a rare occasion, with an incidence of less than 0.5%. The clinical manifestation of a perforated pyometra is non-specific; therefore, it can mimic many other causes of acute abdomen, such as perforated viscus, acute appendicitis, or diverticulitis, which poses unique challenges to diagnosis solely based on clinical information. We reviewed a case of an elderly postmenopausal lady who presented with a sudden onset of generalized abdominal pain, preceded by fever and vomiting. Physical examination revealed a distended abdomen with clinical signs of peritonism. She was initially diagnosed with possible obstructed gastrointestinal carcinoma by clinical examination, with the differential diagnosis of diverticular abscess. Eventually, further abdominal and pelvic contrast-enhanced computed tomography (CECT) study revealed a pyometra with uterine rupture, complicated with pneumoretroperitoneum and pneumoperitoneum. This case emphasizes the value of a CT scan in establishing an accurate diagnosis and early detection of life-threatening complications, such as uterine rupture, as in this case.
脓性子宫积脓合并子宫破裂的情况较为罕见，发生率低于0.5%。脓性子宫积脓穿孔的临床表现不具有特异性；因此，它可能类似于许多其他急腹症的病因，如脏器穿孔、急性阑尾炎或憩室炎，这给仅基于临床信息进行诊断带来了独特的挑战。我们回顾了一例老年绝经后女性病例，该患者在出现发热和呕吐后，突然出现全腹疼痛。体格检查发现腹部膨隆，有腹膜炎的临床体征。通过临床检查，她最初被诊断为可能患有梗阻性胃肠道癌，鉴别诊断为憩室脓肿。最终，进一步的腹部和盆腔增强计算机断层扫描（CECT）检查显示为脓性子宫积脓合并子宫破裂，并伴有腹膜后积气和腹腔积气。该病例强调了CT扫描在准确诊断和早期发现危及生命的并发症（如本例中的子宫破裂）方面的价值。
