Spontaneous uterine rupture in a non-gravid, unscarred uterus secondary to fulminant pelvic infection: a case report

Abstract

Introduction: Spontaneous uterine rupture in a non-gravid, unscarred uterus is an exceedingly rare and life-threatening gynecological emergency. This report details a unique case of such a rupture in a postmenopausal woman, secondary to a fulminant pelvic infection. Case presentation: A 55-year-old grand multipara postmenopausal woman, with a history of recurrent lower abdominal pain, presented with severe abdominal pain, malodorous vaginal discharge, and fever of six days duration. Physical examination revealed a diffusely tender abdomen with guarding, and laboratory investigations showed leukocytosis and anemia. Abdominal ultrasound revealed intra-abdominal collection with an echo complex mass in the paracolic gutter, suggestive of abscess collection in the abdominoplevic cavity. Due to hemodynamic instability, the patient was resuscitated with crystalloids and underwent emergent exploratory laparotomy involving both surgical and gynecologic teams. Intraoperatively, about 2000 ml of purulent material was sucked out, and the uterine fundus was found ruptured, necrotic, and eaten up for which a total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. Microbiological analysis confirmed Escherichia coli infection, and histopathology ruled out malignancy, showing only inflammatory changes. Conclusion: A spontaneous uterine rupture in a non-gravid, unscarred uterus resulted from fulminant pelvic infection, establishing chronic pelvic inflammatory disease as an etiology through direct tissue erosion. This case underscores the necessity of considering genital tract sepsis in postmenopausal women presenting with acute abdomen and highlights the critical importance of emergent surgical intervention, targeted antimicrobial therapy, and rigorous adherence to PID management guidelines for preventing this life-threatening complication.