case_images: PMC8133080_01
case_images: Computed tomography (CT) images of an 83-year-old woman with spontaneous perforation of pyometra. A, CT image shows the presence of a large amount of fluid within the abdominal cavity and free intraperitoneal air (white arrowheads), mostly in the upper abdomen. B, CT image shows a fluid-filled uterus with small air bubbles in the uterus cavity and perforation at the fundus (white arrow) on the right side.
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case_images: In addition, CT imaging showed a fluid-filled uterus with small air bubbles in the uterus cavity and perforation at the fundus on the right side (Fig. 1).
case_images: Intraoperative findings in an 83-year-old woman with spontaneous perforation of pyometra, showing approximately 1,000 mL of purulent fluid in the peritoneal cavity. A perforation measuring 2 x 1 cm in size is observed in the uterine fundus (white arrow). There are no findings suggestive of malignancy in the uterine body or cervix. The sigmoid colon partially adheres to the uterus; however, there are no other abnormal findings in the gastrointestinal tract, gallbladder, and liver.
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case_images: A 2 x 1-cm-sized perforation was observed in the uterine fundus (Fig. 2).
case_images: At initial surgery for an 83-year-old woman with spontaneous perforation of pyometra, 0.4 mug/kg/min epinephrine was given to maintain intraoperative hemodynamics, and 0.5 mug/kg/min norepinephrine and 0.03 U/min vasopressin were given at the end of surgery. Planned reoperation (PRO) was carried out 2 days after the initial surgery. Vasopressin is no longer needed before PRO, and norepinephrine treatment was completed after PRO. Intravenous antibiotics were continued until 9 days after initial surgery. The patient was discharged on the 32nd postoperative day in stable condition. CRP, C-reactive protein; PCT, procalcitonin.
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case_images: The postoperative course is shown in Fig. 3.