Pyometra is the accumulation of purulent material in the uterine cavity. The most common cause of formation of pyometra in elderly women is obstruction to the natural drainage system, which may be caused by malignant or benign conditions. Uterine perforation in a postmenopausal woman with non-malignant etiology is a rare entity, with less than 100 cases reported in the literature. Here we present two cases of postmenopausal women who presented as acute abdomen with suspicion of hollow viscus perforation in one and preoperatively diagnosed uterine perforation in another.
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