Abstract
Pyometra, characterized by the accumulation of purulent material in the uterine cavity, can result in spontaneous uterine perforation, which is a rare but life-threatening complication. This report presents a unique case of uterine perforation as a result of pyometra in a postmenopausal woman. A 52-year-old postmenopausal woman presented to the emergency department with severe abdominal pain, fever, nausea, and vomiting. Clinical suspicion was initially directed toward acute appendicitis. However, imaging revealed pneumoperitoneum with multiple air pockets, suggesting intestinal perforation. Exploratory laparotomy uncovered no bowel perforation but revealed a 2x2 cm uterine fundal perforation with pus drainage. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology confirmed acute necrotizing inflammation extending into the myometrium, with no malignancy detected. Therefore, early diagnosis and surgical intervention, including hysterectomy, are critical for reducing the high morbidity and mortality associated with this condition. Hence, this case underscores the importance of considering uterine perforation as a differential diagnosis in elderly postmenopausal women presenting with acute abdomen for which prompt surgical management is essential to ensure a favorable outcome.