Uterine rupture due to pyometra and imperforate hymen in a 7-year-old girl: A case report

Pyometra is a rare condition characterized by pus accumulation in the uterine cavity primarily affecting postmenopausal women, with only a few cases reported in the pediatric population. A 7-year-old female with developmental delay was brought to the hospital in shock and having clinical signs of peritonitis. Her medical history included abdominal pain and pyuria for one week prior to presentation. The only other positive physical finding was that the hymen was imperforate. An erect abdominal X-ray revealed air under the diaphragm and an ultrasound (US) of the abdomen showed moderate ascites. She was taken to the operating room for an exploratory laparotomy. We found approximately 700 mL of purulent material. The examination of all abdominal organs revealed a perforation at the fundus of the uterus and extensive adhesions. We repaired the uterine wall and left a trans-abdominal drain in the uterine cavity. We also left a drain in the pelvis. We then closed the abdomen and did a hymenoplasty during which we drained 200 additional milliliters of purulent fluid. Cultures were positive for Acinetobacter species. She remained on tobramycin for 10 days. The drains were removed on the 2nd and 5th postoperative days. She was discharged home after an uneventful recovery and has been healthy on all postoperative visits. Female children with imperforate hymen are at risk for pyometra and uterine perforation. A perineal exam should be included in the work up of premenarchal females who present with peritonitis.