Spontaneous Perforated Uterine Pyometra Presenting With Abdominal Pain and Nausea

Pyometra perforation is a rare and severe gynecological acute abdomen. If diagnosis and treatment are not timely, it can lead to septic shock and even endanger the patient's life. Here, we present a 68-year-old postmenopausal woman who presented with symptoms of upper abdominal pain accompanied by nausea. CT indicated a large amount of free gas in the abdominal cavity and fluid in the abdominal and pelvic cavities. Laparotomy was performed considering gastrointestinal (GI) perforation. During the operation, it was diagnosed as perforation of pyometra. After the operation, the patient was transferred to the intensive care unit and died of septic shock 13 hours after the operation. For postmenopausal women with abdominal pain, pyometra perforation should be taken into consideration. Correct identification and timely treatment are particularly crucial for the patient's prognosis.