ABSTRACT

Uterine perforation is a rare condition that must be considered in the differential diagnosis of acute abdominal pain, especially in elderly woman. Delayed diagnosis due to nonspecific symptoms may lead to sepsis caused by purulent material accumulated in the abdominal cavity.An 83-year-old woman was admitted to the emergency department suffering from acute abdominal pain. Physical examination of the abdomen revealed extensive tenderness and muscular rigidity. Due to free air on the abdominal X-ray, perforation of the gastrointestinal tract was diagnosed and an emergency laparatomy was performed. A perforation approximately 25 mm in diameter was found in the uterine corpus and a total hysterectomy with bila-teral salpingo-oopherectomy was carried out. In the culture of purulent fluid anaerobic bacteria were detected and histological examination revealed only necrosis without malignancy. The patient died on the eight postoperative day because of pulmonary complications.Due to the increasing size of the older population, pyometra and related complications may be encountered more frequently. Evaluation of these patients and a correct preoperative diagnosis of pneumoperitoneum caused by pyometra should be considered carefully.