-Case Reports-

Spontaneous Uterine Perforation Due to Clostridial Gas Gangrene Associated with Endometrial Carcinoma

Ryuhei Kurashina, Hiromi Shimada, Takashi Matsushima, Daisuke Doi, Hirobumi Asakura and Toshiyuki Takeshita

Division of Reproductive Medicine, Perinatology and Gynecologic Oncology, Graduate School of Medicine, Nippon Medical School

Few cases of clostridial gas gangrene associated with uterine malignancy have been reported. We report on a 46-year-old woman with clostridial sepsis. On the day of admission due to severe abdominal pain, peritonitis was diagnosed, and computed tomography showed free air in the abdomen. At emergency laparotomy, perforation of the necrotic uterine wall was observed. During hysterectomy, septic shock developed, and life-saving therapy was performed in the intensive care unit after surgery. Pathological examination of the necrotic uterine wall showed grade III endometrial adenocarcinoma of the uterine endometrium (International Federation of Gynecology and Obstetrics stage IIIa) with gas gangrene due to Clostridium perfringens. This report aims to alert gynecologists to the possibility that clostridial gas gangrene of the uterus can occur in patients with peritonitis and intra-abdominal free air. Early recognition and aggressive therapy can save patients' lives.

J Nippon Med Sch 2010; 77: 166-169

Keywords
clostridim perfringens, gas gangrene, clostridial sepsis, uterine endometrial adenocarcinoma, uterine perforation

Correspondence to
Hirobumi Asakura, Nippon Medical School Musasi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
morgen@nms.ac.jp

Received, May 19, 2009
Accepted, January 5, 2010