Publication:

Gas under the diaphragm due to perforation of a gangrenous uterus in a postmenopausal nulliparous woman: a diagnostic and surgical dilemma

Pneumoperitoneum is most commonly associated with hollow viscus perforation. Rare gynecological causes may mimic gastrointestinal pathology, leading to diagnostic dilemmas. Chances of uterine perforation presenting as gas under the diaphragm (pneumoperitoneum) are extremely low, as it's a very rare complication, usually from a perforated pyometra (pus in the uterus), often misdiagnosed as a GI perforation. We report to you a 54-year-old postmenopausal woman presented with acute abdomen and radiological pneumoperitoneum. Emergency exploratory laparotomy revealed pyoperitoneum, a gangrenous perforated uterus, and gangrenous small bowel loops. Subtotal hysterectomy with bowel resection and stoma formation was performed. Intraoperative pus culture grew Escherichia coli. Despite aggressive management, the patient succumbed on postoperative day one.