{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:07:13Z","timestamp":1786118833877,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic toggle=\"yes\">Citrobacter freundii<\/jats:italic>\n                      , sensitive to multiple antibiotics, guiding effective postoperative treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case underscores the need for prompt recognition and aggressive management of pyometra-related uterine perforation in postmenopausal patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2025.111157","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T12:44:23Z","timestamp":1741956263000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Spontaneous uterine perforation due to pyometra: A rare cause of acute abdomen in a postmenopausal woman"],"prefix":"10.1097","volume":"129","author":[{"given":"Alfred","family":"Kishe","sequence":"first","affiliation":[{"name":"St. Joseph Council Designated Hospital, P.O Box 330, Moshi, Kilimanjaro, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deusdedit","family":"William","sequence":"additional","affiliation":[{"name":"St. Joseph Council Designated Hospital, P.O Box 330, Moshi, Kilimanjaro, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipo Godliving","family":"Moshi","sequence":"additional","affiliation":[{"name":"St. Joseph Council Designated Hospital, P.O Box 330, Moshi, Kilimanjaro, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette Antoni","family":"Marandu","sequence":"additional","affiliation":[{"name":"Mawenzi Regional Referral Hospital, P.O Box 3054, Moshi, Kilimanjaro, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Mremi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agathon Avelin","family":"Kimario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"4","key":"R2-55-20260423","doi-asserted-by":"crossref","first-page":"89","DOI":"10.14740\/jcgo830","article-title":"Pyometrium as an early Indicator of cervical squamous cell carcinoma: a systematic review","volume":"11","author":"Derynda,","year":"2022","journal-title":"J. Clin. Gynecol. Obstet."},{"issue":"6","key":"R3-55-20260423","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.18203\/2349-2902.isj20231746","article-title":"Spontaneous uterine perforation presenting as acute abdomen: a diagnostic challenge","volume":"10","author":"Gupta,","year":"2023","journal-title":"Int. Surg. J"},{"issue":"1","key":"R4-55-20260423","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1102\/1470-7330.2009.0002","article-title":"Spontaneous perforation of pyometra in a cervical cancer patient: a case report","volume":"9","author":"Vyas,","year":"2009","journal-title":"Cancer Imaging"},{"issue":"5","key":"R5-55-20260423","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1007\/s005950050624","article-title":"Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: report of a case","volume":"30","author":"Nakao,","year":"2000","journal-title":"Surg. 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Gynecol."},{"issue":"4","key":"R14-55-20260423","first-page":"342","article-title":"Spontaneous perforation of pyometra: a rare cause of acute abdomen and sepsis","volume":"34","author":"Balas,","year":"2018","journal-title":"Turk. J. Surg.Vol."},{"key":"R15-55-20260423","first-page":"1","article-title":"Spontaneous uterine perforation of pyometra presenting as acute abdomen","author":"Kitai,","year":"2014","journal-title":"Case Rep. Obstet. Gynecol.article"},{"key":"R16-55-20260423","first-page":"53","article-title":"Pneumoperitoneum caused by perforation of pyometra associated with a lost intrauterine device","volume":"1","author":"Chen,","year":"2011","journal-title":"Taiwan J. Obstet. 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