Spontaneous Uterine Perforation and the Diagnostic Value of Laparoscopy: A Case Report and Literature Review

Spontaneous uterine perforation due to pyometra, the accumulation of fluid within the uterus, is an uncommon cause of acute abdomen. Malignancy should be ruled out in these cases, as pyometra is often associated with gynecological cancers. Symptoms of perforated pyometra are often vague and mistaken for gastrointestinal perforation. A 74-year-old postmenopausal woman presented with severe abdominal pain and nausea. Due to the nonspecific symptoms and pneumoperitoneum on CT imaging, preoperative assessment was consistent with perforated bowel; however, upon diagnostic laparoscopy and peritoneal lavage, perforated pyometra was found. A total hysterectomy with bilateral salpingo-oophorectomy was subsequently performed. Though rare, perforated pyometra should be considered in postmenopausal females with symptoms of acute abdomen due to its high morbidity and mortality. Diagnostic laparoscopy is effective for diagnosing unclear etiologies of acute abdomen and has many benefits compared to exploratory laparotomy.