A 79-year-old woman was admitted to the department of internal medicine in our hospital because of fever and difficulty in oral intake. The patinet had paresis for polio and cerebral infarction and was staying at a nurising home. After admission a symptomatic remission was temporarily attained by medical treatment including antibiotics, but these symptoms recurred, accompanied by vomiting and abdominal pain. With close examination, the patient was diagnosed as having generalized peritonitis with pyometra and referred to the department. At the time of arrival, the patient showed poor respiratory and circulatory conditions and was in shock state. On the same day an emergency laparotomy was carried out and a perforated pyometra was found out. Since a significant decrease in blood pressure was noted at time of anesthesia induction, peritoneal lavage and peritoneal and trans-peritoneal uterine drainage were conducted. Postoperative course was uneventful. After trans-vaginal uterine drainage were conducted. Postoperative course was uneventful. After trans-vaginal uterine drainage the patient was discharged from the hospital and there has no been no sign of recurrence.
Perforation of pyometra is relatively rare, with 54cases reported in Japan so far. It is common in aged people and so it is often detected after the disease progresses. It has been believed that trans-vaginal uterine drainage is recommended for non-perforated cases and total hysterectomy for perforated cases. But in severe cases like this case, the drainage procedure added by trans-vaginal drainage might be also useful.