{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:26:22Z","timestamp":1790061982589,"version":"4.0.1"},"reference-count":11,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,3,29]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>An elderly female in her 80s with multiple comorbidities presented to our emergency department with a 1-day history of progressive abdominal pain. Physical examination revealed peritonitis on abdominal examination. Laboratory examinations were concerning for sepsis. Contrast-enhanced CT of abdomen and pelvis was suspicious for ischaemic colitis and intra-abdominal abscess. In the setting of peritonitis, exploratory laparotomy was performed and found to have a spontaneous rupture of the uterine fundus causing purulent peritonitis. This was managed with the total abdominal hysterectomy and bilateral salpingo-oophorectomy. The patient had a challenging postoperative course complicated by acute kidney injury, congestive heart failure and failure to thrive. Palliative care was consulted for comfort, and she was discharged to hospice.<\/jats:p>\n               <jats:p>Ruptured pyometra continues to be associated with high mortality despite early and aggressive management, particularly in patients who present with sepsis and organ failure. The diagnosis should be considered in the differential for elderly females who present with emergent surgical abdominal conditions.<\/jats:p>","DOI":"10.1136\/bcr-2024-264188","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T16:25:22Z","timestamp":1744734322000},"page":"e264188","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Diffuse peritonitis secondary to spontaneous perforation of pyometra in an elderly female"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7539-0539","authenticated-orcid":false,"given":"Sagar","family":"Panthi","sequence":"first","affiliation":[{"name":"Department of Surgery, BP Koirala Institute of Health Sciences, Sunsari, Koshi Province, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erfan","family":"Farno","sequence":"additional","affiliation":[{"name":"Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Corbitt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2989-5293","authenticated-orcid":false,"given":"Ariel P","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"2025082723414813000_18.4.e264188.1","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5387\/fms.2019-30","article-title":"Generalized peritonitis secondary to spontaneously perforated pyometra in elderly women:two cases with different clinical courses and surgical approaches and review of the literature","volume":"66","author":"Yazawa","year":"2020","journal-title":"Fukushima J Med Sci"},{"key":"2025082723414813000_18.4.e264188.2","doi-asserted-by":"crossref","first-page":"e231","DOI":"10.1016\/j.jemermed.2016.01.024","article-title":"A Case Report and Literature Review of Spontaneous Perforation of Pyometra","volume":"50","author":"Uno","year":"2016","journal-title":"J Emerg Med"},{"key":"2025082723414813000_18.4.e264188.3","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.ejogrb.2017.08.042","article-title":"Spontaneous uterine rupture due to pyometra, a case report","volume":"217","author":"Emergui Zrihen","year":"2017","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2025082723414813000_18.4.e264188.4","doi-asserted-by":"crossref","first-page":"122","DOI":"10.4274\/tjod.70370","article-title":"Postmenopausal spontaneous uterine perforation: Case report","volume":"12","author":"\u0130\u015flek Se\u00e7en","year":"2015","journal-title":"Turk J Obstet Gynecol"},{"key":"2025082723414813000_18.4.e264188.5","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1002\/jmri.22277","article-title":"Sealed-off spontaneous perforation of a pyometra diagnosed preoperatively by magnetic resonance imaging: a case report","volume":"32","author":"Kim","year":"2010","journal-title":"J Magn Reson Imaging"},{"key":"2025082723414813000_18.4.e264188.6","doi-asserted-by":"crossref","DOI":"10.1093\/jscr\/rjac388","article-title":"Spontaneous perforation of pyometra-is hysterectomy required in the emergent setting? A case report and literature review","volume":"2022","author":"Browne","year":"2022","journal-title":"J Surg Case Rep"},{"key":"2025082723414813000_18.4.e264188.7","article-title":"Spontaneous Rupture of Pyometra Causing Peritonitis in Elderly Female Diagnosed on Dynamic Transvaginal Ultrasound","volume":"2016","author":"Malvadkar","year":"2016","journal-title":"Case Rep Radiol"},{"key":"2025082723414813000_18.4.e264188.8","doi-asserted-by":"crossref","first-page":"504","DOI":"10.5847\/wjem.j.1920-8642.2022.081","article-title":"Spontaneous uterine perforation of pyometra leads to acute abdominal pain and septic shock: a case report","volume":"13","author":"Li","year":"2022","journal-title":"World J Emerg Med"},{"key":"2025082723414813000_18.4.e264188.9","article-title":"Generalized peritonitis secondary to spontaneous perforation of pyometra in a 63-year-old patient","volume":"2013","author":"Abu-Zaid","year":"2013","journal-title":"Case Rep Obstet Gynecol"},{"key":"2025082723414813000_18.4.e264188.10","article-title":"Spontaneous uterine perforation of pyometra presenting as acute abdomen","volume":"2014","author":"Kitai","year":"2014","journal-title":"Case Rep Obstet Gynecol"},{"key":"2025082723414813000_18.4.e264188.11","doi-asserted-by":"crossref","DOI":"10.12659\/AJCR.931167","article-title":"Postoperative Streptococcus constellatus Bacteremia in a 75-Year-Old Patient with Pyometra: A Case Report","volume":"22","author":"Sala","year":"2021","journal-title":"Am J Case Rep"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-264188","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:41:58Z","timestamp":1756363318000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-264188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":11,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,15]]},"published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1136\/bcr-2024-264188"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-264188","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}