Gas under the diaphragm due to perforation of a gangrenous uterus in a postmenopausal nulliparous woman: a diagnostic and surgical dilemma

Sanjana Sanjeev Dubey; Sadiq M. Merchant; Kinjal

doi:10.18203/2349-2902.isj20260862

Authors

Sanjana Sanjeev Dubey Department of General surgery, Bharatratna Dr Babasaheb Ambedkar Municipal General Hospital, Kandivali, Mumbai, Maharashtra, India
Sadiq M. Merchant Department of General surgery, Bharatratna Dr Babasaheb Ambedkar Municipal General Hospital, Kandivali, Mumbai, Maharashtra, India
Kinjal Department of General surgery, Bharatratna Dr Babasaheb Ambedkar Municipal General Hospital, Kandivali, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20260862

Keywords:

Pneumoperitoneum, Pyoperitoneum, Gangrenous uterus

Abstract

Pneumoperitoneum is most commonly associated with hollow viscus perforation. Rare gynecological causes may mimic gastrointestinal pathology, leading to diagnostic dilemmas. Chances of uterine perforation presenting as gas under the diaphragm (pneumoperitoneum) are extremely low, as it's a very rare complication, usually from a perforated pyometra (pus in the uterus), often misdiagnosed as a GI perforation. We report to you a 54-year-old postmenopausal woman presented with acute abdomen and radiological pneumoperitoneum. Emergency exploratory laparotomy revealed pyoperitoneum, a gangrenous perforated uterus, and gangrenous small bowel loops. Subtotal hysterectomy with bowel resection and stoma formation was performed. Intraoperative pus culture grew Escherichia coli. Despite aggressive management, the patient succumbed on postoperative day one.

Metrics

Metrics Loading ...

References

Gupta N, Rawat S, Verma N, Parineeta, Kumar R. Case Report on Spontaneous uterine perforation presenting as acute abdomen: a diagnostic challenge. Int Surg J. 2023;10(6):1099-102. DOI: https://doi.org/10.18203/2349-2902.isj20231746

Sahoo SP, Dora AK, Harika M, Kumar KR. Spontaneous Uterine Perforation Due to Pyometra Presenting as Acute Abdomen. Indian J Surg. 2011;73(5):370-1. DOI: https://doi.org/10.1007/s12262-011-0265-y

Yildizhan B, Uyar E, Si¸ Smanoglu A, Güllüoglu G, Kavak ZN. Spontaneous perforation of pyometra. Infect Dis Obstet Gynecol. 2006;2006:26786. DOI: https://doi.org/10.1155/IDOG/2006/26786

Emergui ZY, Obreros ZLP, García HJA. Spontaneous uterine rupture due to pyometra, a case report. Eur J Obstet Gynecol Reprod Biol. 2017;217:182-3. DOI: https://doi.org/10.1016/j.ejogrb.2017.08.042

Ou YC, Lan KC, Lin H, Tsai CC, Chang Chien CC. Clinical characteristics of perforated pyometra and impending perforation: specific issues in gynecological emergency. J Obstet Gynaecol Res. 2010;36:661-6. DOI: https://doi.org/10.1111/j.1447-0756.2010.01184.x

Williams NM, Watkin DF. Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free gas. Postgrad Med J. 1997;73(863):531-7. DOI: https://doi.org/10.1136/pgmj.73.863.531

Franklin NM, Lafree A, Gocke S, Corbett B, Witucki P, Nene R. Acute pyometra in an elderly female patient: A case report. JEM Reports. 2024;3(1):100065. DOI: https://doi.org/10.1016/j.jemrpt.2023.100065

Lui MW, Cheung V, Pun TC. Clinical significance of pyometra J Reprod Med. 2015;60(7-8):329-32.

Uno K, Tano S, Yoshihara M, Mayama M, Ukai M, Kishigami Y, et al. A case report and literature review of spontaneous perforation of pyometra J Emerg Med. 2016;50(5):e231-6. DOI: https://doi.org/10.1016/j.jemermed.2016.01.024