Pyometra is defined as pooling of purulent material in the uterine cavity. We report a perforated pyometra presented with acute abdomen who was initially diagnosed as gastrointestinal perforation. A 68 year old woman was admitted as an emergency having developed sudden lower abdominal pain. Plain abdominal X-ray revealed free air in the peritoneal cavity. At laparotomy, enlarged perforated uterus of 12x7x4 cm in size was revealed. Hysterectomy and bilateral salpingooophorectomy was performed. Postoperative period was uneventful. Patient was discharged at thirteenth day. Although rare, perforation of pyometra should be considered in the differential diagnosis in an elderly woman with an acute abdomen.