Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study

Abstract

Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study Yingying He1,2,† , Chaoran Li3,† , Fang Long4,† , Zhigang Sun5 , Yangzong Cidan6 , Jing Li7 , Penglong Cao8 , Rui Ma9 , Weiwei Wang10, Xiaoguang Xu11,12, *, Zhen Xiao4,7, * 1 Key Laboratory of Integrated Medicine, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, China 2Department of Pathology, Dalian Maternal and Child Health Hospital, 116021 Dalian, Liaoning, China 3 Performance and Quality Management Department, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, China 4Department of Obstetrics and Gynecology, Institute of High Altitude Medicine, People's Hospital of Naqu Affiliated to Dalian Medical University, 852000 Tibet Autonomous Region, China 5Department of Pathology, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, China 6Department of Obstetrics and Gynecology, People's Hospital of Naqu, 850000 Naqu, Tibet Autonomous Region, China 7Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, China 8Department of Clinical Laboratory, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, China 9Department of Education, First Clinical School of Dalian Medical University, 116011 Dalian, Liaoning, China 10Department of Radiology, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, China 11Department of Neurosurgery, Second Affiliated Hospital of Dalian Medical University, 116022 Dalian, Liaoning, China 12Institute of High Altitude Medicine, People's Hospital of Naqu Affiliated to Dalian Medical University, 852000 Tibet Autonomous Region, China *Correspondence: drxgxu@163.com (Xiaoguang Xu);seriousdoc@163.com (Zhen Xiao) † These authors contributed equally. DOI:10.31083/j.ceog4806210 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 8 December 2020 Revised: 29 April 2021 Accepted: 10 May 2021 Published: 15 December 2021 Background: Spontaneous perforation of pyometra is a rare clinical emergency with high mortality. As pyometra perforation is difficult to recognize pre-operatively, many cases are mis-diagnosed as gastrointestinal (GI) rupture. This study aimed to develop a strategy to improve diagnostic accuracy of spontaneous uterine perforation in female patients with acute abdomen. Methods: Twenty-two women with spontaneous rupture of the uterus (twenty cases previously reported in the literature plus two cases from the authors' hospital) were included in the study group, another 22 menopausal patients with GI perforation were selected as the control group. Radiologists carefully reviewed the CT images and reports and summarized some common signs in patients with spontaneous perforation of pyometra. GI patients' CT images were also scrutinized for these characteristic signs. The occurrence of these features was calculated in both groups. All patients underwent abdominal surgical exploration and most of patients diagnosed with spontaneous perforation of pyometra received hysterectomy and bilateral oophorectomy. Results: Five characteristics were specifically detected in patients with uterine spontaneous perforation: (1) Fluid collected in the cul-de-sac, incidence 95.5%; (2) Fluid in the uterine cavity, incidence 100%; (3) Intrauterine free air, incidence 90.9%; (4) Free air around the uterus, incidence 77.2%; (5) Defects on the uterine wall, incidence 72.7%. However, these five signs were rarely observed in control patients with GI perforation. A dignostic strategy combined clinical findings with raidiological features were developed to help identify these patients. Conclusions: The above five CT characteristics and the developed dignostic algorithm could be used as a tool to facilitate the preoperative diagnosis of spontaneous perforation of pyometra, although more tests are needed in large samples of cases. Keywords Acute abdomen; Computer tomography sign; Pelvic infection; Pyometra; Uterine perforation