Re: baffling case
From: R. Daniel Braun (rd.braun@gmail.com)
Tue May 31 12:09:51 2005
D&C ???????
Imaging does not rule out retained material with 100% accuracy.
What does the wound look like?
On 5/31/05, Richard Chudacoff, MD <rchudacoff@mylinuxisp.com> wrote:
>
> 21 yo G1, GBS negative, admitted through the midwife service 12 days ago.
> She arrested in dilation, after IUPC and FSE, and underwent an unremarkable
> low transverse c-section via Pfannenstiel skin incision 10 days ago. 36
> hours post-op she spike to 103 degrees F and hand a tender uterus, and was
> started on Ampicillin, gentamycin and clindamycin (by the resident on call)
> for post partum endomyometritis. 48 hours post op she was still febrile. ID
> was consulted, after another exam which noted a still tender uterus and she
> was switched to vancomycin and meropenem to cover MRSA as well as the
> usually culprits. She has a history of IBD and grew out C. diff on stool
> culture and was started on Flagyl. She also started taking scheduled Motrin
> and Tylenol. She defervesced for 36 hours and the antibiotics were stopped,
> except for the Flagyl, as were the anti-pyretics. 4 hours later she spiked
> to 103. Antibiotics and anti-pyrectis were restarted. Pelvic U/S was
> negative. KUB to r/o foreign body was negative. CT of pelvis was negative,
> as was chest x-ray, blood cultures and urine culture (from the original
> workup) and all subsequent cultures have been negative. She defervesed, and
> was stable for 24 hours. Anti-pyrectics were stopped 48 hours ago, and she
> then spiked again, despite being on anti-biotics. Repeat CT is negative, as
> is repeat CXR. Doppler studies of the lower extremities are negative, with
> great flow bilaterally. GI consults negative. No evidence of cardiac valve
> abnormalities ruling out SBE.
>
> I'm thinking that the only thing left to try is heparin for septic pelvic
> thrombophelbitis or septic gonadal thrombophelbitis. I thought she might
> have a drug fever, however she did spike after discontinuation of the wonder
> drugs.
>
> Any thoughts, pearls, questions, and acceptance of transfer to your
> service would be appreciated.
>
> Richard Chudacoff, MD, FACOG
>
> Women's Specialists of Houston
>
> 6624 Fannin Suite 1800
>
> Houston, TX, 77030
>
> 713-797-1144
>
> 713-425-3071
>
> Email: Richard.Chudacoff@obgyn.net
>
> rchudacoff.md@womenspecialists.com
>
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--
R. Daniel Braun
Kinky for Governor
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