Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

Table 1

Cases of spontaneous perforation of pyometra from the literature review and our own case.

Patients	First author	Age	Symptoms	Preoperative diagnosis	Associated malignancy	Perforation site	Bacterial culture	Treatment	Immunocompromised state	Outcome
1	Nuamah [4]	79	AP, F, and V	PGIT	None	Fundus	ND	TAH + BSO	ND	Died (MOF)
2	Shahid [5]	80	AP	PGIT	CC	Fundus	ND	TAH + BSO	ND	Survived
3	Chan [6]	73	AP, shock	PP	None	Fundus	Klebsiella pneumoniae, Streptococcus viridans	TAH + BSO	DM	Survived
4	Tsai [7]	40	AP, F	GP	None	Fundus	ND	STH	ND	Survived
5	Yildizhan [8]	92	AP, V	PGIT	None	Fundus	Escherichia coli, Bacteroides fragilis	TAH + BSO	ND	Survived
6	Geranpayeh [9]	63	AP, F, and V	PGIT	None	ND	Negative	TAH + BSO	ND	Survived
7	Lee [10]	60	AP, F	PGIT	CC	Fundus	B. fragilis	TAH + BSO	DM, RF	ND
8	Saha [3]	60	AP	PGIT	None	Fundus	Staphylococcus aureus	SVH + BSO	ND	Survived
9	Li [11]	69	AP, F, and V	PGIT, GP	None	Anterior	B. fragilis	SVH + BSO	None	Survived
10	Vyas [12]	60	AP, V	PP	CC	Fundus	Acinetobacter species	Drainage	ND	Survived
11	Izumi [13]	83	AP	PP	None	Fundus	Bacteroides distasonis, Porphyromonas asaccharolytica, and Streptococcus oralis	TAH	None	Survived
12	Ou [14]	78	AP, F	PGIT	SCC	ND	ND	TAH + BSO	ND	ND
13		54	AP, F	Pneumoperitoneum	None	ND	ND	TAH + BSO	ND	ND
14		78	AP	PP	CC	ND	ND	TAH + BSO	ND	ND
15		80	AP	PGIT	CC	ND	ND	Drainage	ND	ND
16		73	AP, F	PP	CC	ND	ND	TAH + BSO	ND	ND
17		81	AP, F	GP	None	ND	ND	TAH	ND	ND
18	Kim [15]	80	AP	PP	None	Fundus	ND	TAH + BSO	None	Survived
19	Chen [16]	68	AP, F	PGIT	SCC	Fundus	ND	TAH + BSO + OME	ND	Survived
20	Agarwal [17]	60	AP, F	PGIT	CC	Fundus	ND	Drainage	ND	Survived
21	Stunell [18]	64	AP	PP	None	Fundus	ND	TAH + BSO	None	ND
22	Lim [19]	89	AP, F	GPIT	None	Fundus	E. coli	TAH + BSO	None	Survived
23		87	AP	GPIT	None	Fundus	Enterococcus faecalis	Surgical closure	None	ND
24	Chaopotong [20]	88	AP, F, and V	GP	None	Fundus	Negative	TAH + BSO	DM	Died (sepsis)
25	Sahoo [21]	50	AP, F, and shock	GPIT	None	Fundus	ND	TAH + BSO	ND	Survived
26	Shapey [22]	84	AP, V	GPIT	None	Anterior	Negative	TAH	Steroid administration	Survived
27	Ikeda [23]	80	AP	PP	CC	Anterior	E. coli	TAH + BSO	None	Survived
28		81	AP, F	PGIT	None	Fundus	E. coli	TAH + BSO	None	Survived
29		93	AP, F	PGIT	None	Posterior	K. pneumoniae, Enterococcus faecalis, and Streptococcus species	TAH	None	Survived
30		84	AP	PGIT	SCC	Anterior	E. coli	TAH + BSO	None	Survived
31		74	AP, F	PP	None	Fundus	E. coli, Staphylococcus epidermidis	STH + BSO	None	Survived
32		79	AP, F	Appendicitis	None	Fundus	E. coli	TAH	None	Survived
33		66	Shock	PP	None	Anterior	K. pneumoniae	Drainage	DM	Died (strangulation ileus)
34	Kutuk [24]	71	AP, F, and V	GP	None	Fundus	E. coli	TAH + BSO	ND	Survived
35		75	AP, V	Mesenteric artery ischemia	None	Fundus	Negative	TAH + BSO	None	Survived
36		68	AP	GPIT	None	Posterior	E. coli	TAH + BSO	RF	Died (sepsis)
37	Hagiya [25]	86	AP, shock	PP	None	Fundus	Actinomyces species	TAH + BSO	DM	Survived
38	Mallah [26]	78	AP, F, and V	Incarcerated hernia	None	Fundus	ND	TAH + BSO	None	Survived
39		61	AP, F, V, and shock	GP	None	Posterior	ND	TAH + BSO	None	Survived
40	Abu-Zaid [27]	63	AP, F, and V	PP	None	Fundus	Streptococcus constellatus	TAH + BSO	None	Survived
41	Patil [28]	74	AP, F	PGIT	None	Fundus	ND	TAH + BSO	DM	Survived
42	Kitai [present case]	66	AP, V	PP	None	Fundus	E. coli, B. fragilis	SVH + BSO	RF, steroid administration	Died (sepsis)

AP: abdominal pain; F: fever; V: vomiting; PGIT: perforation of the gastrointestinal tract; PP: perforation of pyometra; GP: generalized peritonitis; CC: cervical cancer; SCC: sigmoid colon cancer; TAH: total abdominal hysterectomy; STH: subtotal hysterectomy; SVH: supravaginal hysterectomy; BSO: bilateral salpingo-oophorectomy; DM: diabetes mellitus; RF: renal failure; MOF: multiple organ failure.