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X-ray of the abdomen reveals pneumoperitoneum and an intrauterine device located in the right lower quadrant.
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The intrauterine device (IUD) is a popular family planning method worldwide. Some of the complications associated with insertion of an IUD are well described in the literature. The frequency of IUD perforation is estimated to be between 0.05 and 13 per 1000 insertions. There are many reports of migrated intrauterine devices, but far fewer reports o...
The intrauterine device is the most used long-acting reversible contraceptive method, presenting a low incidence of complications. The authors present a case of an intrauterine device migration, with an uterine perforation by its lower extremity.
ABSTRACT
Intrauterine devices (IUDs) are widely used for reversible contraception. Perforation of the uterus and
migration of the device into the retroperitoneal or abdominal cavity is a major but an infrequent
complication. We present this report to highlight two interesting aspects of this case: One is that two IUDs
were present simultaneousl...
Synopsis
Ectopic intrauterine devices to the gastric wall are extremely rare and they can be managed by upper gastrointestinal endoscopy.
Objective:
Intrauterine devices (IUDs) are globally one of the most popular methods of contraception. Uterine perforation is one of the most significant complications of IUD use and commonly occurs at the time of IUD insertion rather than presenting as delayed migration. This paper reports a series of 13 cases of displaced IUDs requiring retrieval...
Citations
... Several reports have been published about colouterine fistulas caused by diverticulitis of the sigmoid colon [8]. There are few reports on malignancy associated with a colouterine fistula [9,10]. Unfortunately, our patient was diag- nosed as having colorectal cancer invading the uterine body. ...
Pyometra usually develops in elderly women, and it can be caused by various etiologies. We describe a rare case of pyometra with a colouterine fistula due to rectal cancer presenting as acute abdomen. A 67-year-old woman with purulent vaginal discharge and abdominal distension was referred to our hospital for suspected pyometra. Because the vaginal echogram showed pyometra at her initial medical examination, drainage was performed. Her symptoms subsequently disappeared temporarily, but 4 months later, she developed acute abdomen. The computed tomography scan showed a pelvic mass with expansion of the intestine. The patient underwent en bloc resection of the mass. Histopathologic analysis of the tumor showed rectal cancer with invasion of the uterus and ileum, and a colouterine fistula. Although pyometra due to a colouterine fistula is a very rare condition, the incidence of associated malignancy is considerable. Physicians should be aware of this potential presentation of colorectal cancer.
... Pyometra is a condition where there is collection of a lot of purulent material in the uterine cavity. [1][2][3][4][5] Primary squamous cell carcinoma of the endometrium is a rare condition and squamous cell carcinoma in situ of the endometrium is more uncommon condition and both can be associated with pyometra. There are very few cases of primary squamous cell carcinoma of the endometrium with ichthyosis uteri and to the best of our knowledge only six cases have been reported in literature. ...
Primary squamous cell carcinoma in situ of the endometrium is an extremely rare condition. It may be associated with pyometra. We report a case of a 71 year old, postmenopausal woman who presented with burning micturition, increased urine frequency and lower abdominal distention. Radiological findings were suggestive of pyometra or hematometra of the uterus. Hysterectomy was performed and histopathological examination was done, which was suggestive of primary squamous cell carcinoma in situ of the endometrium
... Pyometra is defined as the collection of pus in the uterine cavity. The main cause of pyometra is cervical canal occlusion usually secondary to carcinoma cervix; however, other benign causes are endometrial polyp, leiomyoma, infection especially senile cervicitis, a forgotten intrauterine device, cervical occlusion after surgery, and radiation123. The usual presentation of pyometra is a whitish discharge per vaginum. ...
Pyometra is collection of pus within the uterine cavity and is usually associated with underlying gynaecological malignancy or other benign causes. Spontaneous rupture of pyometra is a rare complication. We report a case of a 65-year-old female who presented with acute abdomen and was diagnosed with a ruptured uterus secondary to pyometra and consequent peritonitis on dynamic transvaginal sonography (TVS) which was later confirmed on contrast enhanced computed tomography (CECT). An emergency laparotomy was performed and about 800 cc of pus was drained from the peritoneal cavity. A rent was found in the anterior uterine wall and hence hysterectomy was performed. Histopathology revealed mixed inflammatory cell infiltrate with no evidence of malignancy. There are only 31 cases of ruptured pyometra reported till date, most of which were definitively diagnosed only on laparotomy. In only two of these cases the preoperative diagnosis was made on CECT. We report this case, as the correct and definitive diagnosis was made preoperatively on dynamic TVS. To our knowledge,
this is the first case report revealing spontaneous ruptured pyometra being diagnosed preoperatively on dynamic TVS
. This report is aimed at giving emphasis on the use of simple dynamic TVS for accurate diagnosis of rare spontaneous ruptured pyometra causing peritonitis.
... These possible factors include endometrial polyp, leiomyoma, cervical or endometrial carcinoma, and infection especially senile cervicitis (4,5). However other factors can be considered as following conditions such as a forgotten IUD, cervical occlusion after surgery, and radiation (6). Furthermore, idiopathic reasons should be noted. ...
Pyometra is an accumulation of purulent material or pus in the uterine cavity. Spontaneous perforation of uterus by pyometra is rare. This is a clinical presentation and management of a spontaneous perforation of uterine caused by pyometra.
This is a case report on spontaneously perforated associated with pyometra secondary to cervical malignancy. The patient underwent exploratory laparotomy with total hysterectomy and bilateral salpingo-oophorectomy.
Spontaneous rupture of pyometra duo to cervical cancer in cases of acute abdomen in elderly patients should be considered.
... Recognition and aggressive management of this condition are essential because it still carries significant risk of morbidity and mortality [1]. Several factors that increase the risk of pyometra have been identified, including viral or bacterial cervicitis, radiation exposure, the presence of foreign bodies in the uterine cavity (e.g., intrauterine devices), exposure to chemical agents, estrogen treatment, vitamin A deficiency, and intracavitary tumors [1,5]. It is noteworthy that pyometra can be the first sign of an underlying neoplasm; malignancies are the underlying cause of this condition in 3.5e45% of all cases [2]. ...
... Immediate laparotomy, peritoneal lavage, and even hysterectomy are indicated in the presence of suspected perforation of pyometra, as in our case. Unfortunately, these procedures carry a high risk of morbidity and death, especially in elderly patients with severe underlying medical conditions [4,5]. Ultrasound is an essential diagnostic tool for both pyometra and cervical malignancies. ...
... A PubMed search was conducted using the keyword 'pyometra' and English language articles were retrieved. A review of all cases was performed including the reviews by Yildizhan et al. [15] and Ou et al. [16] and we found an additional 2 cases of spontaneously perforated pyometra [17,18]. Only 38 cases of spontaneously perforated pyometra have been reported. ...
... Spontaneous uterine rupture is rare. Only 38 cases of spontaneous perforation of pyometra have been reported15161718, of which 36 have been included in the reviews by Yildizhan et al. and Ou et al. Ou et al. had the largest number of reported patients with spontaneous perforation of pyometra treated in a single centre to date, where out of the 20 women with pyometra, 6 were perforated [16]. ...
The acute abdomen accounts for up to 40% of all emergency surgical hospital admissions and a large proportion are secondary to gastrointestinal perforation. Studies have shown the superiority of the abdominal CT over upright chest radiographs in demonstrating free intraperitoneal air. Spontaneous perforated pyometra is a rare cause of the surgical acute abdomen with free intraperitoneal air. Only 38 cases have been reported worldwide.
We report 2 cases of spontaneously perforated pyometra in our hospital's general surgery department. Both underwent exploratory laparotomy: one had a total hysterectomy and bilateral salpingo-oophorectomy, while the other had an evacuation of the uterine cavity, primary repair of uterine perforation and a peritoneal washout. A literature search was conducted and all reported cases reviewed in order to describe the clinical presentations and management of the condition. Of the 40 cases to date, including 2 of our cases, the most common presenting symptoms were abdominal pain (97.5%), fever (37.5%) and vomiting (25.0%). The main indication for exploratory laparotomy was pneumoperitoneum (97.5%).
Pyometra is an unusual but serious condition in elderly women presenting with an acute abdomen. A high index of suspicion is needed to make the appropriate diagnosis.
... The treatment methods for pyometra include proper drainage of the uterine cavity and administration of antibiotics effective against aerobic and anaerobic bacteria. The most common etiological organisms is E. coli which is facultatively anaerobic [10]. Since perforated pyometra is diffi cult to diagnose preoperatively, it requires emergency operation. ...
Pyometra is an uncommon condition in general population and caused by impairment of natural drainage of the cervix as a result of benign or malignant diseases. Spontaneous uterine perforation, a very rare complication of pyometra, carries significant morbidity and mortality and should be considered in the differential diagnosis of other peritonitis. Preoperative diagnosis of perforated pyometra is difficult due to old age, poor general condition, and symptoms that present as abdominal pain related to gastrointestinal diseases. If a diagnosis of perforated pyometra is delayed, then it will be associated with increased morbidity and mortality. In the causes of uterine perforation, pyometra should be considered because of requiring proper intervention. A diagnosis of spontaneous perforated pyometra should always be kept as a possibility in all cases of abdominal pains associated with peritonitis in elderly women.
The aging of general population has brought to an increased urgent condition among geriatric patients. Since 1970, laparoscopy has become the gold standard for several gynaecological disease although its use in emergency is not so wide.
The expansion of the elderly population led to an increased number of older adults presenting to emergency departments following trauma; the outcome of injuries in geriatric patients is worsened by a weaker mechanism of compensation, ongoing chronic medical conditions, and increased risk for complications due to a greater number of comorbidities and physiological changes.
