Spontaneous Perforation of Pyometra: A Report of Seven Cases and Review of the Literature

<b><i>Background/Aims:</i></b> The spontaneous perforation of pyometra is very rare and is associated with a poor prognosis. The present study aimed to evaluate the clinical characteristics and prognostic factors for patient survival. <b><i>Patients and Methods:</i></b> We reported on 7 patients with spontaneous rupture of pyometra. We also reviewed 47 additional published cases. Thus, all 54 patients were analyzed for mortality. <b><i>Results:</i></b> We investigated the prognosis in 44 of 54 patients, excluding 8 patients with undocumented outcome and 2 who died of other diseases. The mortality rate was 25% (11 of 44). In univariate analysis, variables such as age, correct preoperative diagnosis, comorbidities, the presence of malignancy, and hysterectomy were not significant between surviving and deceased patients. In bacterial cultures from the peritoneal cavity, the most common etiological organisms were <i>Escherichia coli</i> and anaerobes such as <i>Bacteroides</i> and <i>Peptococcus</i> species. The rate of isolation of anaerobic bacteria was significantly increased in patients who died (odds ratio, 6.33; 95% confidence interval, 1.28-31.02; p = 0.04). <b><i>Conclusion:</i></b> Antibiotic therapy for <i>E. coli</i> and anaerobes should be considered in patients with spontaneous perforation of pyometra.