A rare case of spontaneous uterine perforation in post-menopausal woman

A 55 year old postmenopausal woman was brought to casualty department of C. U. Shah Medical College and Hospital with history of fall down with lower abdominal pain and vomiting. Patient having history of lower abdominal pain, non foul smelling whitish discharge, low grade on and off fever since 1 year associated with gradual weight loss since 2 years. Per abdominal examination reveals tender, distended with muscle rigidity. Exploratory laparotomy was performed under the diagnosis of perforation of GI tract with x-ray showing free gas under diaphragm. On exploration, the uterus was found to have fundal perforation of size 2x2 cm in dimension. With purulent material extruding from uterine cavity and abdominal cavity filled with purulrnt discharge around 1.5 litre. A Total abdominal hysterectomy with bilateral Salpingoophrectomy was performed uneventful and peritoneal cavity wash given with normal saline multiple times. Patient recovered completely without any complications and was discharged. Perforation due to pyometra can cause peritonitis in post menopausal females with signs of acute abdomen as an unusual but serious condition.