A 68-year old, multiparous, post-menopausal woman was admitted to surgical emergency of our institute with features of acute abdomen. Her abdominal examination revealed marked guarding and tenderness. Plain abdominal radiograph revealed multiple air fluid levels with no free air under the diaphragm. Ultrasonography of the abdomen revealed free fluid in the abdominal cavity. With these findings, a clinical diagnosis of perforation peritonitis was made and exploratory laparotomy was planned. Broad spectrum antibiotics were started. Laparotomy revealed a collection of one litre purulent fluid in the abdominal cavity, with no perforation in the gastrointestinal tract or gall bladder.
The uterus was gangrenous in the fundal area and was found to have two perforations, one approximately of 2 cm diameter in the posterior wall and second of one cm diameter in the dome.
A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The cervix and vagina did not reveal any abnormality. Histopathological examination of the specimen revealed features of gangrene and perforation with no evidence of malignancy. The patient was discharged on 10 th day, in a healthy condition with no major postoperative complications.
gangrenous uterus?god :'|
