Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study
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...
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| Format: | Article |
| Language: | English |
| Published: |
IMR Press
2021-12-01
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| Series: | Clinical and Experimental Obstetrics & Gynecology |
| Subjects: | |
| Online Access: | https://www.imrpress.com/journal/CEOG/48/6/10.31083/j.ceog4806210 |
| _version_ | 1818005898042277888 |
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| author | Yingying He Chaoran Li Fang Long Zhigang Sun Yangzong Cidan Jing Li Penglong Cao Rui Ma Weiwei Wang Xiaoguang Xu Zhen Xiao |
| author_facet | Yingying He Chaoran Li Fang Long Zhigang Sun Yangzong Cidan Jing Li Penglong Cao Rui Ma Weiwei Wang Xiaoguang Xu Zhen Xiao |
| author_sort | Yingying He |
| collection | DOAJ |
| description | 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) Intra-uterine 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. |
| first_indexed | 2024-04-14T04:52:42Z |
| format | Article |
| id | doaj.art-15303b3b3f2e44b0af46e7053ef83204 |
| institution | Directory Open Access Journal |
| issn | 0390-6663 |
| language | English |
| last_indexed | 2024-04-14T04:52:42Z |
| publishDate | 2021-12-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Clinical and Experimental Obstetrics & Gynecology |
| spelling | doaj.art-15303b3b3f2e44b0af46e7053ef832042022-12-22T02:11:14ZengIMR PressClinical and Experimental Obstetrics & Gynecology0390-66632021-12-014861324132910.31083/j.ceog4806210S0390-6663(21)01634-1Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control studyYingying He0Chaoran Li1Fang Long2Zhigang Sun3Yangzong Cidan4Jing Li5Penglong Cao6Rui Ma7Weiwei Wang8Xiaoguang Xu9Zhen Xiao10Key Laboratory of Integrated Medicine, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, ChinaPerformance and Quality Management Department, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, ChinaDepartment of Obstetrics and Gynecology, Institute of High Altitude Medicine, People’s Hospital of Naqu Affiliated to Dalian Medical University, 852000 Tibet Autonomous Region, ChinaDepartment of Pathology, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, ChinaDepartment of Obstetrics and Gynecology, People’s Hospital of Naqu, 850000 Naqu, Tibet Autonomous Region, ChinaDepartment of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, ChinaDepartment of Clinical Laboratory, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, ChinaDepartment of Education, First Clinical School of Dalian Medical University, 116011 Dalian, Liaoning, ChinaDepartment of Radiology, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, ChinaDepartment of Neurosurgery, Second Affiliated Hospital of Dalian Medical University, 116022 Dalian, Liaoning, ChinaDepartment of Obstetrics and Gynecology, Institute of High Altitude Medicine, People’s Hospital of Naqu Affiliated to Dalian Medical University, 852000 Tibet Autonomous Region, ChinaBackground: 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) Intra-uterine 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.https://www.imrpress.com/journal/CEOG/48/6/10.31083/j.ceog4806210acute abdomencomputer tomography signpelvic infectionpyometrauterine perforation |
| spellingShingle | Yingying He Chaoran Li Fang Long Zhigang Sun Yangzong Cidan Jing Li Penglong Cao Rui Ma Weiwei Wang Xiaoguang Xu Zhen Xiao Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study Clinical and Experimental Obstetrics & Gynecology acute abdomen computer tomography sign pelvic infection pyometra uterine perforation |
| title | Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study |
| title_full | Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study |
| title_fullStr | Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study |
| title_full_unstemmed | Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study |
| title_short | Five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen: a case control study |
| title_sort | five abdominal computer tomography characteristics facilitate diagnosis of spontaneous perforation of pyometra in women with acute abdomen a case control study |
| topic | acute abdomen computer tomography sign pelvic infection pyometra uterine perforation |
| url | https://www.imrpress.com/journal/CEOG/48/6/10.31083/j.ceog4806210 |
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