Laparoscopic uterine-preserving management of ruptured pyometra using open drainage: a case report

Ruptured pyometra is a rare but life-threatening condition that often presents with generalized peritonitis and septic shock, particularly in elderly patients. Although total hysterectomy with peritoneal lavage has traditionally been the standard treatment, it may impose excessive physiological stress in patients with poor general condition. We report a case of an elderly woman with ruptured pyometra who was treated with laparoscopic uterine-preserving management using open drainage. Intraoperatively, uterine perforations with purulent discharge were identified. Instead of closing the perforation, the uterine wall was intentionally incised to widely open the abscess cavity, allowing thorough irrigation of the uterine cavity and sustained drainage. This approach prioritized effective source control over anatomical repair. The postoperative course was favorable, and recurrent infection was successfully managed with additional minimally invasive drainage. This case suggests that laparoscopic open drainage without closure of uterine perforation may be a viable, life-saving option in selected high-risk patients.