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Re: Thoughts on managementFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Sat Jan 24 16:12:52 2004
At Sat, 24 Jan 2004, Tami wrote: > >Any suggestions for management with the following patient: >36y G0 long hx of endometriosis on continuous ocps with good control of her pain. Seen with c/o vaginal discharge--in a rainbow of colors (pink brown red orange) with a foul odor. Her "endometriosis doctor" did cultures/wet mount--all negative, then tx'd her with a week of flagyl and then a week of doxy with no improvement. >Exam normal --all vag type testing neg, but with a yellow dc that she says requires changing a pad almost hourly. Us shows an approx 8x7x7cm hematoma located between the endometrium and myometrium connecting to the cavity by a "crack" in the endometrium. No signs of any other myometrial abnormality; mri shows same. Endo bx showed "chronic endometritis, no atypia". >I'm considering a hysteroscopy, although I'm not sure if it will be helpful for diagnosis or treatment. I think she's heading towards a hyst for both diagnosis and treatment, but wanted to hear other thoughts. > >Thanks. >Tami Dairiki M.D. >private practice >Scottsdale, AZ >
Is the hemotoma located high near the fundus if so then I would consider
a rudimentary horn that is only partial emptying durring menstration it
would be strange to present this late in life but not unheard of.
Endometriosis could be
secondary to retrograde flow which is common in severe forms of
bicornate,rudimentary horn etc. It is unfortunteate that she has no
children, and yes hyst in the end may offer her best chance for long
term relief.
>
--
Take care, John
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