PDF(Pubmed)
Abstract：
Spontaneous perforations in pyometra occur rarely. Incidence is only 0.01%-0.5% in gynecological patients. Tubo-ovarian abscess (TOA) is seen less in postmenopausal women amounting the 6%-18% of the total cases of TOA reported. A 52-year-old P3L3 postmenopausal woman with abdominal pain was admitted to hospital. Emergency laparotomy was performed in view of pyoperitoneum. Intraoperatively, 1000 cc of foul-smelling pus was suctioned out from the peritoneal cavity a 2 cm × 2 cm sized perforation was seen at the right fundal region of the uterus and a right sided TOA was seen extending to the uterine cavity, left sided ovary was normal. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The patient got discharged on the 36th postoperative hospitalization day. Histopathological study revealed uterine purulent inflammation with no evidence of malignancy. The diagnosis of spontaneous perforation of pyometra is rarely made preoperatively and the possibility of a perforated pyometra should, therefore, be considered when elderly women suffer from acute abdominal pain. Hysterectomy and bilateral salpingo-oophorectomy may be the best choice procedure in these patients. There is probably a new trend in the epidemiology of TOA, occurring in older women who do not present the traditional risk factors for pelvic inflammatory disease and TOA.
摘要：
子宫积脓中的自发性穿孔很少发生。妇科患者的发病率仅为0.01％-0.5％。绝经后妇女的卵巢脓肿（TOA）较少，占报告的TOA总病例的6％-18％。一名52岁的P3L3绝经后妇女因腹痛入院。鉴于腹膜积脓，进行了紧急剖腹手术。术中,从腹膜腔抽吸出1000cc恶臭脓液，在子宫右底区可见2cm×2cm大小的穿孔，右侧TOA延伸至子宫腔。左侧卵巢正常。进行了全腹子宫切除术和双侧附件卵巢切除术。患者于术后第36天出院。组织病理学研究显示子宫化脓性炎症，没有恶性肿瘤的证据。术前很少诊断自发性子宫积脓穿孔，应考虑子宫积脓穿孔的可能性，因此,当老年妇女患有急性腹痛时考虑。子宫切除术和双侧输卵管卵巢切除术可能是这些患者的最佳选择。TOA的流行病学可能有一个新趋势，发生在没有盆腔炎和TOA传统危险因素的老年女性中。
