An Unusual Etiology of Spontaneous Pyometra Perforation; A Case Report
A 60-year-old postmenopausal, para 2 woman presented with acute central abdominal pain for the past 12 hours along with abdominal distension. The pain was intermittent, non-radiating and non-colicky. She also gave a history of mild fever for 3 days associated with chills but no rigors. There was no history of prolonged illness, medication use or intervention in the past. On examination, vitals were stable. There was mild abdominal distension with tenderness and guarding on per-abdomen examination. Bowel sounds were present with no obvious palpable organomegaly. Abdominal x-rays showed free air under diaphragm with no distended bowel loops or air fluid levels. Being an endemic region, a provisional clinical diagnosis of enteric perforation with subsequent peritonitis was made and the patient was planned for urgent exploratory laparotomy by surgeons.\nPreoperatively, there was about 100 ml of pus with soft bulky uterus perforated at fundus which had sealed. Extensive lavage of abdominal cavity was done. Bilateral thickened uterosacral and a short pelvic wall raised strong suspicion of cervical cancer and accompanying pyometra. On per speculum examination, the cervix was found flushed with vagina. A cervical biopsy was taken and pyometra was drained vaginally.\nPost-operatively, the patient's cervical biopsy was confirmatory of carcinoma cervix. Patient had good post-operative recovery. Contrast enhanced computerized tomography was done post operatively to assess tumor extent () in consultation with a gyneco-oncologist to plan further treatment according to its staging. The patient received radiotherapy in view of advanced stage of cervical cancer and was placed under follow up.