General Gynaecology

0010 Spontaneous uterine rupture secondary to pyometra in a cervical cancer patient: a case report Maria Concepcion Cenizal, Leo Francis Aquilizan St. Luke’s Medical Center, Quezon City, Metro Manila, The Philippines Pyometra is a rare gynecologic disease entity with an incidence of 0.01–0.5% among all gynecologic patients and 13.6% among elderly gynecologic patients. It is the accumulation of pus within the uterine cavity which is commonly caused by a blockage or compromise in the outflow tract of the uterus. Pyometra in itself is rare, much so is uterine rupture occuring secondary to it. There is no local data available that reported incidence of ruptured pyometra in the Philippines. This is a case of a 63 year old Gravida 5 Para 5 (5–0–0-4), diagnosed case of Cervical Endometrioid Adenocarcinoma Stage IIIB, who was presented with abdominal pain. Computed Tomography Scan of the whole abdomen with intravenous contrast revealed moderate pneumoperitoneum of indeterminate etiology, for which an initial assessment of acute abdomen secondary to pneumoperitoneum probably secondary to ruptured viscus was made. Patient underwent exploratory laparotomy. Intraoperative finding was ruptured pyometra and peritoneal toilette and insertion of drainage were subsequently done. Culture guided antibiotics were administered and patient underwent radiotherapy and brachytherapy after infectionwas resolved. Spontaneous rupture of pyometra with associated malignancy is a serious medical condition which requires prompt surgical and medical management. However, preoperative diagnosis is difficult despite the presence of advanced imaging techniques, hence high level of suspicion is warranted in identifying this condition. Accurate diagnosis of pyometra prior to rupture may require less invasive management, therefore it is of same importance to identify presence of pyometra even before it leads to its catastrophic complications.