A Case of Pan-peritonitis due to Perforation of the Pyometra as a Result of Invasion of Rectal Cancer to the Uterus
We report a rare case of panperitonitis due to pyometral perforation due to rectal cancer invading the uterus. An 88-year-old woman with a high fever and appetite loss was diagnosed with panperitonitis due to appendix perforation, demonstrated by palpation, which showed diffuse muscle guarding, and...
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| Published in | Nippon Shokaki Geka Gakkai zasshi Vol. 38; no. 4; pp. 469 - 473 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Society of Gastroenterological Surgery
2005
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.38.469 |
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| Abstract | We report a rare case of panperitonitis due to pyometral perforation due to rectal cancer invading the uterus. An 88-year-old woman with a high fever and appetite loss was diagnosed with panperitonitis due to appendix perforation, demonstrated by palpation, which showed diffuse muscle guarding, and abdominal computed to-mography (CT), which showed an abscess around the appendix. Emergency surgery showed perforation of the uterine fundus, which had been invaded by rectal cancer involving the left ovary, necessitating resection of the rectum, uterus, and left ovary. Pathologically, rectal cancer had metastasized to the uterus, where contamination uterine cavity contributed to pyometral perforation when progressing rectal cancer obstructed the uterus. The possibility of pyometral perforation should thus be considered in elderly women diagnosed with generalized peritonitis. The peritoneal cavity must also be thoroughly examined to rule out the rare inva-sion of malignant cancer. |
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| AbstractList | We report a rare case of panperitonitis due to pyometral perforation due to rectal cancer invading the uterus. An 88-year-old woman with a high fever and appetite loss was diagnosed with panperitonitis due to appendix perforation, demonstrated by palpation, which showed diffuse muscle guarding, and abdominal computed to-mography (CT), which showed an abscess around the appendix. Emergency surgery showed perforation of the uterine fundus, which had been invaded by rectal cancer involving the left ovary, necessitating resection of the rectum, uterus, and left ovary. Pathologically, rectal cancer had metastasized to the uterus, where contamination uterine cavity contributed to pyometral perforation when progressing rectal cancer obstructed the uterus. The possibility of pyometral perforation should thus be considered in elderly women diagnosed with generalized peritonitis. The peritoneal cavity must also be thoroughly examined to rule out the rare inva-sion of malignant cancer. |
| Author | Sogahata, Katsuya Mizushima, Yasuhiro Someya, Tetsufumi Yasoshima, Takahiro Matsumura, Nobuyuki Kawamoto, Masaki Nomura, Hiroki Sato, Takashi Hirata, Koichi Hata, Fumitake |
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| References | 13) Sugarbaker PH, Corlew S: Influence of surgical techniques on survival in patients with colorectal cancer. Dis Colon Rectum 25: 545-547, 1982 1) Inui A, Nitta A, Yamamoto A et al: Generalized peritonitis with pneumoperitoneum caused by the spontaneous perforation of pyometra without malignancy: report of a case. Surg Today 29: 935-938, 1999 17) Lehnert T, Methner M, Pollok A et al: Multivis-ceral resection for locally advancer primary colon and rectal cancer-an analysis of prognostic factors in 201 patients. Ann Surg 235: 217-225, 2002 18) Orkin MA, Dozors RR, Beart RW et al: Ex-tended resection for locally advanced primary adeno-carcinoma of the rectum. Dis Colon Rectum 32: 286-292, 1989 19) Welch JP, Donaldson GA: Perforative carcinomaof colon and rectum. Ann Surg 180: 734, 1974 12) 小野利夫, 阿部博昭, 山下三郎ほか: 子宮留膿腫穿孔による汎発性腹膜炎の3症例. 日農村医会誌 49: 631-636, 2000 3) Nakao A, Mimura H, Fujisawa K et al: General-ized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: Re-port of a case. Surg Today 30: 454-457, 2000 22) 田中千凱, 伊藤隆夫, 加藤元久ほか: 直腸子宮瘻と子宮留膿腫を伴った直腸癌の1例. 消外 8: 1627-1630, 1985 24) 隅田英典, 片岡誠, 桑原義之ほか: 直腸癌子宮瘻に起因する子宮留膿腫が穿孔し汎発性腹膜炎を生じた一例-自験例を含めた本邦報告例36例の検討-. 外科治療 73: 355-359, 1995 10) 藤社勉, 遠藤秀彦, 佐藤武彦ほか: 子宮留膿腫穿孔による汎発性腹膜炎の一例. 日臨外会誌 59: 2926-2929, 1998 7) Bui A, Wilkinson S: Generalized peritonitis due to spontaneous rupture of pyometra. Aust NZ J Obstet Gynaecol 29: 82-83, 1989 16) Curley SA, Carlson GW, Shumate CR et al: Ex-tended resection for locally advanced colorectal carcinoma. Am J Surg 163: 553-559, 1992 2) Muram D, Drouin P, Thompson FE: Pyometra. CMAJ 125: 589-592, 1981 4) 赤澤憲治, 高森久純, 安田博ほか: 老年婦人の子宮留膿症. 日産婦会誌43: 1539-1545, 1991 23) 高橋利通, 笠岡千孝, 小林俊介ほか: 子宮留膿腫として発症した直腸癌の1 例. 日本大腸肛門病会誌 45: 224-227, 1992 14) 福田一郎, 亀山雅男, 河崎靖仁ほか: 直腸癌隣接臓器合併切除例の検討. 日消外会誌 20: 1739-1742, 1987 21) 庄司宗弘, 竹井信夫, 山口敏朗: 内瘻を形成した結腸癌の六例. 日本大腸肛門病会誌 31: 87, 1978 11) 岡崎誠, 山村順, 川崎靖仁ほか: 直腸癌に併存した子宮留膿腫のため壁深達度診断が困難であった一例. 日消外会誌 34: 64-67, 2001 20) Miller LD, Boruchow IR, Fitts WT: An analysis of 284 patients with perforative carcinoma pf the colon. Surg Gynecol Obstet 123: 1212-1218, 1966 9) 栗田智子, 畑中浩一, 土岐尚之ほか: 子宮頸癌による子宮留膿腫のため自然子宮穿孔をきたした2例. 日産婦会誌52: 825-829, 2000 5) 中久保善敬, 奥芝知郎, 直江和彦ほか: 子宮留膿腫穿孔による汎発性腹膜炎の2例. 日腹部救急医会誌 20: 701-705, 2000 15) 加藤知行, 平井孝, 金光幸秀: 原発性直腸癌における隣接臓器合併切除. 消外 26: 335-342, 2003 8) 山下博士, 坂本昌士, 山本修ほか: 子宮留膿腫穿孔による汎発性腹膜炎の一例. 臨外 49: 1495-1499, 1994 25) MacMahon CE, Lund P: Gastrocolic fistulae of malignant origin. A consideration of its nature and report of five cases. Am J Surg 106: 333, 1963 6) 中川加寿夫, 野中雅彦, 中西正樹: 子宮留膿腫穿孔による汎発性腹膜炎の一例. 日臨外会誌 59: 829-832, 1998 |
| References_xml | – reference: 10) 藤社勉, 遠藤秀彦, 佐藤武彦ほか: 子宮留膿腫穿孔による汎発性腹膜炎の一例. 日臨外会誌 59: 2926-2929, 1998 – reference: 3) Nakao A, Mimura H, Fujisawa K et al: General-ized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: Re-port of a case. Surg Today 30: 454-457, 2000 – reference: 11) 岡崎誠, 山村順, 川崎靖仁ほか: 直腸癌に併存した子宮留膿腫のため壁深達度診断が困難であった一例. 日消外会誌 34: 64-67, 2001 – reference: 21) 庄司宗弘, 竹井信夫, 山口敏朗: 内瘻を形成した結腸癌の六例. 日本大腸肛門病会誌 31: 87, 1978 – reference: 12) 小野利夫, 阿部博昭, 山下三郎ほか: 子宮留膿腫穿孔による汎発性腹膜炎の3症例. 日農村医会誌 49: 631-636, 2000 – reference: 17) Lehnert T, Methner M, Pollok A et al: Multivis-ceral resection for locally advancer primary colon and rectal cancer-an analysis of prognostic factors in 201 patients. Ann Surg 235: 217-225, 2002 – reference: 14) 福田一郎, 亀山雅男, 河崎靖仁ほか: 直腸癌隣接臓器合併切除例の検討. 日消外会誌 20: 1739-1742, 1987 – reference: 25) MacMahon CE, Lund P: Gastrocolic fistulae of malignant origin. A consideration of its nature and report of five cases. Am J Surg 106: 333, 1963 – reference: 20) Miller LD, Boruchow IR, Fitts WT: An analysis of 284 patients with perforative carcinoma pf the colon. Surg Gynecol Obstet 123: 1212-1218, 1966 – reference: 23) 高橋利通, 笠岡千孝, 小林俊介ほか: 子宮留膿腫として発症した直腸癌の1 例. 日本大腸肛門病会誌 45: 224-227, 1992 – reference: 1) Inui A, Nitta A, Yamamoto A et al: Generalized peritonitis with pneumoperitoneum caused by the spontaneous perforation of pyometra without malignancy: report of a case. Surg Today 29: 935-938, 1999 – reference: 5) 中久保善敬, 奥芝知郎, 直江和彦ほか: 子宮留膿腫穿孔による汎発性腹膜炎の2例. 日腹部救急医会誌 20: 701-705, 2000 – reference: 18) Orkin MA, Dozors RR, Beart RW et al: Ex-tended resection for locally advanced primary adeno-carcinoma of the rectum. Dis Colon Rectum 32: 286-292, 1989 – reference: 4) 赤澤憲治, 高森久純, 安田博ほか: 老年婦人の子宮留膿症. 日産婦会誌43: 1539-1545, 1991 – reference: 9) 栗田智子, 畑中浩一, 土岐尚之ほか: 子宮頸癌による子宮留膿腫のため自然子宮穿孔をきたした2例. 日産婦会誌52: 825-829, 2000 – reference: 2) Muram D, Drouin P, Thompson FE: Pyometra. CMAJ 125: 589-592, 1981 – reference: 7) Bui A, Wilkinson S: Generalized peritonitis due to spontaneous rupture of pyometra. Aust NZ J Obstet Gynaecol 29: 82-83, 1989 – reference: 8) 山下博士, 坂本昌士, 山本修ほか: 子宮留膿腫穿孔による汎発性腹膜炎の一例. 臨外 49: 1495-1499, 1994 – reference: 19) Welch JP, Donaldson GA: Perforative carcinomaof colon and rectum. Ann Surg 180: 734, 1974 – reference: 22) 田中千凱, 伊藤隆夫, 加藤元久ほか: 直腸子宮瘻と子宮留膿腫を伴った直腸癌の1例. 消外 8: 1627-1630, 1985 – reference: 16) Curley SA, Carlson GW, Shumate CR et al: Ex-tended resection for locally advanced colorectal carcinoma. Am J Surg 163: 553-559, 1992 – reference: 6) 中川加寿夫, 野中雅彦, 中西正樹: 子宮留膿腫穿孔による汎発性腹膜炎の一例. 日臨外会誌 59: 829-832, 1998 – reference: 13) Sugarbaker PH, Corlew S: Influence of surgical techniques on survival in patients with colorectal cancer. Dis Colon Rectum 25: 545-547, 1982 – reference: 15) 加藤知行, 平井孝, 金光幸秀: 原発性直腸癌における隣接臓器合併切除. 消外 26: 335-342, 2003 – reference: 24) 隅田英典, 片岡誠, 桑原義之ほか: 直腸癌子宮瘻に起因する子宮留膿腫が穿孔し汎発性腹膜炎を生じた一例-自験例を含めた本邦報告例36例の検討-. 外科治療 73: 355-359, 1995 |
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| Title | A Case of Pan-peritonitis due to Perforation of the Pyometra as a Result of Invasion of Rectal Cancer to the Uterus |
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