Spontaneous uterine perforation presenting as acute abdomen: a diagnostic challenge


  • Niraj Gupta Department of Surgery, Dr. RPGMC Kangra, Tanda, Himachal Pradesh, India
  • Shelja Rawat MO Specialist, CH Kangra, Himachal Pradesh, India
  • Nitin Verma Department of Surgery, Dr. RPGMC Kangra, Tanda, Himachal Pradesh, India
  • Parineeta Department of Surgery, Dr. RPGMC Kangra, Tanda, Himachal Pradesh, India
  • Rohit Kumar Department of Surgery, Dr. RPGMC Kangra, Tanda, Himachal Pradesh, India




Uterine perforation, Pyometra, Postmenopausal, Pneumoperitoneum, Case report


Spontaneous uterine perforation resulting in generalized peritonitis in postmenopausal women is a very rare entity usually caused by pyometra and is associated with high morbidity and mortality. The clinical picture of uterine perforation secondary to pyometra are similar to hollow viscus perforation which makes preoperative diagnosis difficult. Definitive diagnosis can be made with laparotomy or laparoscopy. We report a case of 62 years old female patient who presented with acute generalized peritonitis with pneumoperitoneum having history of pigtail insertion right kidney for right non-functional kidney with gross hydronephrosis two days back, which was more complicating the clinical picture. This case report aims to alert surgeons to the possibility that uterine perforation secondary to pyometra also shows air under diaphragm apart from hollow viscus perforation.


Browne IL. Spontaneous perforation of pyometra-is hysterectomy required in the emergent setting? A case report and literature review. J Surg Case Rep. 2022;2022(8):rjac388.

Yildizhan B, Uyar E, Sişmanoğlu A, Güllüoğlu G, Kavak ZN. Spontaneous perforation of pyometra. Infect Dis Obstet Gynecol. 2006;26786.

Saha PK, Gupta P, Mehra R, Goel P, Huria A. Spontaneous perforation of pyometra presented as an acute abdomen: a case report. Medscape J Med. 2008;10(1):15.

Harika NS, Rao TUM, Sireesha P, Jithendra D, Pandu SS. A rare case of gas under diaphragm due to spontaneous perforation of uterus due to gas gangrene of uterus with clostridium perfringens infection presenting as intestinal perforation. Int Surg J. 2019;6:3009.

Desai AY, Palande B, Dhabolkar S, Pai VD. Perforative peritonitis-gastrointestinal tract may not always be the source. Indian J Surg. 2017;79:160-2.

Balas Ş, Yılmaz KB, Yıldırım SA, Açıkgöz B, Tatar İG, Bayar B, et al. Spontaneous perforation of pyometra: A rare cause of acute abdomen and sepsis. Turk J Surg. 2018;34(4):342-5.

Yousefi Z, Sharifi N, Morshedy M. Spontaneous uterine perforation caused by pyometra: a case report. Iran Red Crescent Med J. 2014;16:14491.

Kerimoglu OS, Pekin A, Yilmaz SA, Bakbak BB, Celik C. Pyometra in elderly post-menopausal women: a sign of malignity. Eur J Gynaecol Oncol. 2015;36:59-61.

Kitai T, Okuno K, Ugaki H, Komoto Y, Fujimi S, Takemura M. Spontaneous uterine perforation of pyometra presenting as acute abdomen. Case Rep Obstet Gynecol. 2014;738568.

Halpin TF, Molinari JA. Diagnosis and management of clostridium perfringens sepsis and uterine gas gangrene. Obstet Gynecol Surv. 2002;57(1):53-7.






Case Reports