Spontaneous Perforation of Pyometra in a Postmenopausal Woman with Intrauterine Device Presenting with Septic Shock: A Case Report and Review of Published Cases
Abstract
Background: Pyometra is an uncommon gynecologic disorder characterized by the accumulation of pus within the uterine cavity typically resulting from cervical obstruction. Spontaneous perforation of pyometra (SPP) is extremely rare but may rapidly progress to generalized peritonitis and septic shock. We report a case of SPP in a postmenopausal woman initially misdiagnosed as gastrointestinal perforation and review the literature to highlight diagnostic pitfalls and management strategies.
Case presentation: A 69-year-old postmenopausal woman presented with acute abdominal pain, fever, vomiting, and septic shock. CT demonstrated pneumoperitoneum and ascites, suggestive of gastrointestinal perforation. An emergency laparotomy was performed, which identified a 4-cm perforation in the posterior uterine wall with purulent intraperitoneal fluid. Total hysterectomy with bilateral salpingo-oophorectomy and drainage was performed. Postoperatively, the patient developed respiratory failure but recovered and was discharged on postoperative day 28.
Discussion: We conducted a retrospective analysis of 66 SPP cases identified from the published literature, encompassing cases from the first report in 1985 through 2025, with the present case included. Among the 63 patients with sufficient diagnostic data, the preoperative misdiagnosis rate was approximately 84%. Nonspecific gastrointestinal symptoms were the major cause of diagnostic delay. CT may be one of the more informative imaging…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 66 participants or records.
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