Spontaneous uterine perforation due to pyometra: A rare cause of acute abdomen in a postmenopausal woman

INTRODUCTION: Spontaneous uterine perforation due to pyometra is a rare but serious condition. Pyometra refers to the accumulation of purulent material within the uterine cavity, typically resulting from an obstruction of the cervical canal combined with infection. When left untreated, the pressure from the accumulated fluid and the inflammatory response can lead to spontaneous uterine rupture. This condition often presents as an acute abdomen and can be life-threatening particularly in postmenopausal women. CASE PRESENTATION: We present the case of a 71-year-old woman, para 8, who presented with acute abdomen characterized by generalized peritonitis. Diagnostic imaging revealed a fluid-filled, thickened endometrium with a complex pelvic collection. Emergency laparotomy revealed uterine fundal perforation with approximately 2 L of purulent material in the peritoneum. Subtotal hysterectomy + bilateral salpingo- Oophorectomy and extensive peritoneal lavage were performed. Cultures identified Citrobacter freundii, sensitive to multiple antibiotics, guiding effective postoperative treatment. DISCUSSION: Early surgical intervention is critical to prevent complications such as sepsis and multiorgan failure, which significantly contribute to the high morbidity and mortality rates of this condition. CONCLUSION: This case underscores the need for prompt recognition and aggressive management of pyometra-related uterine perforation in postmenopausal patients.