A Case of Pan-peritonitis due to Perforation of the Pyometra as a Result of Invasion of Rectal Cancer to the Uterus

Katsuya Sogahata¹⁾²⁾, Yasuhiro Mizushima³⁾, Nobuyuki Matsumura¹⁾, Masaki Kawamoto¹⁾, Hiroki Nomura³⁾, Fumitake Hata¹⁾, Tetsufumi Someya²⁾, Takahiro Yasoshima¹⁾, Takashi Sato²⁾ and Koichi Hirata¹⁾

First Department of Surgery, Sapporo Medical University, School of Medicine¹⁾
Hokkaido Prefectural Haboro Hospital²⁾
Ashibetsu Municipal Hospital³⁾

We report a rare case of panperitonitis due to pyometral perforation due to rectal cancer invading the uterus. An 88-year-old woman with a high fever and appetite loss was diagnosed with panperitonitis due to appendix perforation, demonstrated by palpation, which showed diffuse muscle guarding, and abdominal computed tomography (CT), which showed an abscess around the appendix. Emergency surgery showed perforation of the uterine fundus, which had been invaded by rectal cancer involving the left ovary, necessitating resection of the rectum, uterus, and left ovary. Pathologically, rectal cancer had metastasized to the uterus, where contamination uterine cavity contributed to pyometral perforation when progressing rectal cancer obstructed the uterus. The possibility of pyometral perforation should thus be considered in elderly women diagnosed with generalized peritonitis. The peritoneal cavity must also be thoroughly examined to rule out the rare invasion of malignant cancer.

Key words
pyometra, rupture of uterus, rectal cancer

Reprint requests
Katsuya Sogahata Hokkaido Prefectural Haboro Hospital
94 Sakaemachi, Haboro-cho, Tomamae-gun, 078-4197 JAPAN

Accepted
November 30, 2004

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