Ahmet KARAMERCAN, Bülent AYTAÇ, Aydan BİRİ, Hande DENİZ

Pneumoperitoneum caused by perforatino of pyometra without malignancy

Uterus perforasyonu özellikle yalşı kadın hastalarda akut karın ayrıcı tanısında dikkatle değerlendirilmesi gereken nadir bir durumdur. Spesifik olmayan semptomlara bağlı olarak tanıda gecikilmesi, karın içerisinde biriken pürülan materyal nedeniyle sepsise yol açabilir. Acil servise karın ağrısı nedeniyle başvuran 83 yaşında bayan hastanın fizik muayenesinde abdominal hassasiyet ve musküler rigidite tesbit edildi. Direkt grafilerinde karın içerisinde serbest hava saptanması üzerine gastrointestinal perforasyon düşünülen hasta acil laparatomiye alındı. Operasyonda uterus korpusu üzerinde yaklaşık 25mm lik bir perforasyon görülen hastaya total abdominal histerektomi-bilateral salpingooferektomi uygulandı. Yapılan kültürde anaerobik bakteriler üredi ve histopatolojik incelemede malignite olmaksızın nekroz tesbit edildi. Hasta postoperatif 8. günde pulmoner komplikasyonlara bağlı olarak exitus oldu. Yaşlı popülasyonun artışına bağlı olarak pyometra ve ilgili komplikasyonlar daha sık görülmektedir. Pyometraya bağlı bir pneumoperitoneumun preop-ratif doğru tanısının konulabilmesi için bu hastaların dikkatle değerlendirilmesi gereklidir.

Malignite olmaksızın pyometra perforasyonuna bağlı gelişen pneumoperitoneum

Uterine perforation is a rare condition that must be considered in the differential diagnosis of acute abdominal pain, especially in elderly woman. Delayed diagnosis due to nonspecific symptoms may lead to sepsis caused by purulent material accumulated in the abdominal cavity. An 83-year-old woman was admitted to the emergency department suffering from acute abdominal pain. Physical examination of the abdomen revealed extensive tenderness and muscular rigidity. Due to free air on the abdominal X-ray, perforation of the gastrointestinal tract was diagnosed and an emergency laparatomy was performed. A perforation approximately 25 mm in diameter was found in the uterine corpus and a total hysterectomy with bilateral salpingo-oopherectomy was carried out. In the culture of purulent fluid anaerobic bacteria were detected and histological examination revealed only necrosis without malignancy. The patient died on the eight postoperative day because of pulmonary complications. Due to the increasing size of the older population, pyometra and related complications may be encountered more frequently. Evaluation of these patients and a correct preoperative diagnosis of pneumoperitoneum caused by pyometra should be considered carefully.

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