A Case of Panperitonitis due to Perforation of the Pyometra caused by Diverticulitis of the Sigmoid Colon

Koji Tanaka, Hiroshi Nakamura, Hiroshi Kuwabara, Kazumi Nakajima and Narihide Goseki

Department of Surgery, Shuwa General Hospital

A 79-year-old woman with abdominal pain and signs of peritoneal irritation on palpation was found in computed tomograghy to have a large amount of free air, many diverticula of the sigmoid colon, and a tumor with the collection of fluid and air in the pelvic cavity. Suspecting panperitonitis due to perforation of the sigmoid colon diverticula accompanied by an abscess, we conducted emergency surgery. Laparotomy showed perforation of the fundus uteri and purulent discharge. The sigmoid colon with a thickened wall adhered to the reddened and enlarged left oviduct, necessitating total hysterectomy with left salpingo-oophorectomy and sigmoidectomy with descending colostomy under diagnosis of panperitonitis caused by the perforation of pyometra and diverticulitis of the sigmoid colon. Pathological findings showed that the uterus was pyometric and suggested fistula formation between the sigmoid colon and the oviduct as evidenced by remains of food in the oviduct wall near the adherent sigmoid colon and the severe inflammation around it. This is an extremely rare case of panperitonitis due to perforation of pyometra associated with sigmoid colon diverticulitis.

Key words
pyometra, uterine perforation, diverticulitis

Reprint requests
Koji Tanaka Department of Proctology, Social Health Insurance Hospital
3-22-1 Hyakunintyo, Sinjuku-ku, 169-0073 JAPAN

Accepted
March 25, 2009

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