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Query: UMLS:C0000727 (acute abdomen)
 3,084 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pyometra, an accumulation of purulent material in the uterus, is a rare pathologic entity. Spontaneous rupture of pyometra occurred secondary to degenerating leiomyomata; that is an extremely rare complication. Pyometra, the diagnosis of which is based on the classic symptoms of uterine enlargement, vaginal discharge and acute abdomen, requires rapid supportive therapy and surgical intervention.
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PMID:Spontaneous rupture of pyometra due to leiomyomata. A case report. 374 96

Spontaneously perforated pyometra is rare, but the condition must be born in mind in women with acute abdomen. Two cases are reported, one resembling perforated peptic ulcer, the other was mistaken for acute appendicitis.
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PMID:Spontaneously perforated pyometra. A differential diagnosis in acute abdomen. 409 83

Spontaneous perforation is a very rare complication of pyometra. We report herein the case of an 88-year-old woman who presented with muscular rigidity and free air on abdominal X-ray films. Perforation of the gastrointestinal tract was diagnosed preoperatively, and an emergency laparotomy was performed. A total hysterectomy with bilateral salpingo-oophorectomy was carried out under the diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra. The culture of purulent fluid from the abdominal cavity showed only Escherichia coli, with no anaerobic bacteria. Histological examination revealed pyometra with necrosis of the endometrium and no evidence of malignancy. The patient was discharged on postoperative day 68 without any major complications. Pyometra is an unusual cause of peritonitis, but it must be considered as a possible diagnosis in elderly women presenting with an acute abdomen. Following this case report, we discuss the problems associated with establishing a correct preoperative diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra.
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PMID:Generalized peritonitis with pneumoperitoneum caused by the spontaneous perforation of pyometra without malignancy: report of a case. 1048 41

Clinical approach to a patient with acute abdominal distress involves decision making: whether to take a patient to surgery, or manage the patient medically. A thorough and systematic approach requires the use of diagnostic imaging modalities, including radiology and ultrasonography, performing diagnostic peritoneal lavage or abdominal paracentesis techniques, and bloodwork evaluation, including complete blood count and serum biochemistry profiles. In some cases, the results of diagnostic tests may lead to surgical versus medical management, particularly when a patient fails to respond to medical management alone. In other cases, such as GDV syndrome, penetrating abdominal wounds, pyometra, or uncontrolled abdominal hemorrhage, rapid surgical management is necessary for patient survival. This article describes a systematic approach to a small animal patient with acute abdomen.
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PMID:The acute abdomen: a surgeon's approach to diagnosis and treatment. 1277 70

Pneumoperitoneum (PP) is usually the result of perforation of the gastrointestinal (GI) tract with associated peritonitis. However, other rare causes, including spontaneous PP incidental to intrathoracic, intra-abdominal, gynecologic, and miscellaneous other origins not associated with a perforated GI tract have been described in the literature. Six cases of PP without any perforated GI tract are reported. Three patients with generalized peritonitis underwent exploratory laparotomy or laparoscopy when clinical examinations suggested an acute abdomen. At surgical procedure, perforated pyometra, perforated liver abscess and a ruptured necrotic lesion of a liver metastasis were documented in these patients, respectively. We also saw 3 PP patients not associated with peritonitis. Two patients with PP caused by pneumatosis cystoides intestinalis were encountered, 1 was managed conservatively and the other received diagnostic laparoscopy. A patient in whom pneumomediastinum and pneumoretroperitoneum were accompanied by PP caused by an alveolar rupture based on decreased pulmonary compliance due to malnutrition was managed conservatively. The history of the patient and knowledge of the less frequent causes of PP can possibly contribute towards refraining from exploratory laparotomy in the absence of peritonitis.
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PMID:Pneumoperitoneum without perforation of the gastrointestinal tract. 1280 2

We performed a retrospective observational review-based study of the medical records of consecutive women with diagnosis of spontaneous uterine perforation, between 1995 and 2003. During this period 3 patients with an average age of 76.2 years and with acute abdominal pain attended to the emergency department. Physical examination revealed signs of peritoneal irritation, as a result emergency laparotomy was performed, where uterine perforation was not found in the preoperative diagnosis. All patients had purulent fluid in the abdominal cavity and uterine perforation. A total abdominal hysterectomy with bilateral salpingooophorectomy was carried out under the diagnosis of generalized peritonitis caused by spontaneous perforation of pyometra. They also required cavity lavage, drainages placement, and antibiotics. Histological examination revealed uterine perforation and pyometra without evidence of malignancy. Prognosis was good and they were discharged on postoperative day 8.5 without complications. Spontaneous uterine perforation, secondary to pyometra, should be considered in the differential diagnosis of acute abdomen in postmenopausal patients, still without gynecological signs.
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PMID:[Spontaneous uterine perforation secondary to pyometra: a report of three cases]. 1630 72

Spontaneous perforation of pyometra is an extremely rare emergent gynecologic disease. We report a 73-year-old woman with a spontaneously perforated pyometra presenting with acute abdomen in the emergency department. A dedicated computed tomography examination of the abdominal and pelvic regions revealed the diagnosis. The patient recovered well after surgical intervention and antibiotic treatment.
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PMID:Computed tomography features of spontaneously perforated pyometra: a case report. 1660 73

A 71-year-old female with rheumatoid arthritis and chronic use of corticosteroids presented to the emergency room with 2 weeks of urinary symptoms, abdominal pain and a mass located in hypo-mesogastrium and both flanks. An X-ray film of the abdomen showed that bowels were displaced by the mass. Laboratory studies showed thrombocytosis (549,000/mm(3)) and leukocytosis (41,800/mm(3)). Several hours after her arrival the patient developed acute abdomen and surgery was indicated. A urinary catheter drained 2100 ml of urine and the abdominal mass was reduced in size but did not disappear. Surgery demonstrated that the urinary bladder covered the fundus and the anterior face of the uterus, where extensive necrosis and a 3-cm perforation were found; 400 ml of foul-smelling pus was drained from the uterine cavity. Due to necrosis, a hysterectomy was performed. The histopathological report indicated necrosis, atrophic cervicitis and endometritis; pus culture developed Escherichia coli and Proteus vulgaris. Despite administration of broad-spectrum antibiotics, the patient developed severe sepsis and died 11 days postoperatively. During a literature review, only one similar case was found. Acute abdomen due to uterine perforation secondary to pyometra and associated with chronic use of corticosteroids is a rare complication.
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PMID:[Acute abdomen secondary to spontaneous uterine rupture associated with pyometra]. 1688 87

Spontaneous perforation of pyometra is a rare pathologic condition that presents as diffuse peritonitis. This report describes an interesting case of spontaneous uterine perforation that mimicked gut perforation clinically and was finally diagnosed at exploratory laparotomy. Although rare, perforation of pyometra should be kept as one of the differential diagnosis in an elderly woman with an acute abdomen. A high index of suspicion is required to make a correct preoperative diagnosis, which allows early intervention, thus reducing morbidity and mortality.
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PMID:Spontaneous perforation of pyometra presented as an acute abdomen: a case report. 1832 25

We report herein a case of spontaneous perforation of pyometra leading to diffuse peritonitis. This pathological condition is rare, and preoperative diagnosis is difficult. We were able to make the correct diagnosis preoperatively using contrast-enhanced abdominopelvic computed tomography. Both intrauterine and extrauterine fluid collections and defects of the uterine fundus were key findings, and reconstructed sagittal and coronal images were useful. In elderly female patients presenting with acute abdomen, ruptured pyometra should be considered as a possibility.
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PMID:Computed tomography findings of spontaneous perforation of pyometra. 2043 40


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