Uterine perforation in pyometra presenting as acute generalized peritonitis with untreated cervical cancer : a case report

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  • UMEDA Anna
    Department of Obstetrics and Gynecology, Sakai City Hospital
  • KUSHIMOTO Takuya
    Department of Obstetrics and Gynecology, Sakai City Hospital
  • FUKUI Kaoru
    Department of Obstetrics and Gynecology, Sakai City Hospital
  • ONO Ryoko
    Department of Obstetrics and Gynecology, Sakai City Hospital
  • KAZUMI Kumiko
    Department of Obstetrics and Gynecology, Sakai City Hospital
  • MIYANISHI Kazuya
    Department of Obstetrics and Gynecology, Sakai City Hospital
  • BOKU Kosei
    Department of Obstetrics and Gynecology, Sakai City Hospital
  • YAMAMOTO Toshiya
    Department of Obstetrics and Gynecology, Sakai City Hospital

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Other Title
  • 子宮留膿症からの子宮穿孔により急性汎発性腹膜炎を発症した子宮頸癌の１例
  • 症例報告 子宮留膿症からの子宮穿孔により急性汎発性腹膜炎を発症した子宮頸癌の1例
  • ショウレイ ホウコク シキュウリュウノウショウ カラ ノ シキュウ センコウ ニ ヨリ キュウセイ ハンハツセイ フクマクエン オ ハッショウ シタ シキュウケイガン ノ 1レイ

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Abstract

Uterine perforation is a rare disease. Most cases are related to pregnancy, uterine surgery and pyometra. We report a case of spontaneous uterine perforation in pyometra presenting as acute generalized peritonitis in a patient with untreated cervical cancer. A nulligravida 41-year-old woman had been experiencing abnormal genital bleeding for several months. She visited her family doctor to seek treatment for abdominal pain and fever. However, her symptoms worsened; therefore, she consulted a local gynecologist and was referred to our hospital. We noted a bloody odorous discharge and a tumor in the uterine cervix. Physical examination indicated generalized peritonitis, and laboratory data showed high C-reactive protein (CRP) levels (24.1 mg/dl). We diagnosed cervical cancer with generalized peritonitis and started antibiotic therapy. However, subsequently, we decided to perform an emergent operation because antibiotic therapy was ineffective and magnetic resonance examination revealed perforation of the uterine wall. Modified radical hysterectomy, bilateral salpingo-oophorectomy, right external iliac lymphadnectomy, and peritoneal lavage and drainage were performed. The postoperative diagnosis was uterine cervical adenocarcinoma stage IB1. Histological examination showed no cancer cells in the perforated region, but the findings revealed right external iliac lymphadenopathy. Laparotomic lavage and drainage were performed because the inflammation did not improve, and computed tomography showed an abscess in the epiploic foramen. Two months after the 2nd operation, she recovered and postoperative chemotherapy (TC) was started. Most cases of uterine perforation involved a serious disease course because of the difficulty in diagnosis. Early diagnosis and treatment are required in cases with uterine perforation. The possible presence of uterine malignant tumor should also be considered. [Adv Obstet Gynecol, 65 (1) : 83-89, 2013 (H25.2)]

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