OB-GYN-L Messages for September, 2005: Re: Opinions on laparoscopy (long)

Re: Opinions on laparoscopy (long)
From: Terrence.Jones@kp.org
Wed Sep 28 20:57:26 2005

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Glen, now that we know there's no urologic injury, would attribute the bump in creat to Gm neg endotoxin after starting cipro. Was the pulmonary effusion the attributable cause for the desat on POD #2? (ie: other than low risk by Hx - how were You reassured, at the time, She did not have a PE?) Endotoxin- mediated pulm cap leak is less likely cause for the desat - as it occurred prior to cipro (coliforms still breeding), and responded to minimal O2 supplmt'n.. Subjacent ascites with subsequent splinting and effusion would not likely cause an acute event? Wonder if She had a delayed hypersensitivity reaction? Is she atopic or a health care worker? Was the rectal probe covered with a latex sheath? She had a prior surgery - might have been sensitized at that time. /tj
"Elrod Darryl G MAJ 48 MDOS/SGOBO" <Darryl.elrod@LAKENHEATH.AF.MIL> Sent by: ob-gyn-l@obgyn.net 09/28/2005 03:18 PM Please respond to ob-gyn-l
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> cc: Subject: RE: Opinions on laparoscopy (long)
Good news. Her IVP was normal. No extravasations from the bladder or ureter. Both ureters clearly seen from kidney to bladder as well.
I'm sure they could have told me as much from the CT I did a couple days ago, but there is something satisfying about seeing a full IVP films to show that all is well.
So far, she has been afebrile and tolerating po for the last 24 hrs.
We may never really know what caused any of this. Makes me wonder how her pelvic pain will be now!
Glen
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------------------------------------------------------ New this morning is her C diff is positive. ------------------------------------------------------
I can't wait to dictate this discharge summary.
------------------------------------------------------
We used to leave 1L of fluid or more in the pelvis for "floatation effect" ------------------------------------------------------ to avoid adhesion formation so i don't think leaving her a bit wet was an ------------------------------------------------------ issue.
-------------------------------------------------------
had previously had laparoscopy for pelvic pain where they fulgurated ------------------------------------------------------- endometriosis. ------------------------------------------------------- I had a rectal probe in the rectum and a sponge stick in the vagina to be able to locate these. Blood loss was about 100ml. On POD 2 now, she became hypoxic with desats to the 80s on RA. O2 was added and she came back up to normal.
At the same time she became tachycardic with HR to 130s. EKG, CXR and KUB were orderd.
EKG-sinus tach CXR-right pleural effusion KUB-dilated large bowel with all bowels apparently pushed to the midline, with presumptive diagnosis of ascites.
--------------------------------------------------------
Foley gets put in with 1000ml out, grossly infected and subsequently -------------------------------------------------------- grows out E coli. Cipro started. --------------------------------------------------------
BUN/Cr bump to 25/2.5 IVF changed and within a day renal function normalizes. Renal ultrasound normal. Ascites confirmed. Pt still is not passing flatus nor tolerating any clears.
CT scan today shows clearance of pleural effusions, large amount of ascites but no dilated bowels or signs of abscess.
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         Glen, now that we know there's no urologic injury, would attribute the bump in creat to Gm neg endotoxin after starting cipro. Was the pulmonary effusion the attributable cause for the desat on POD #2? (ie: other than low risk by Hx - how were You reassured, at the time, She did not have a PE?) Endotoxin- mediated pulm cap leak is less likely cause for the desat - as it occurred prior to cipro (coliforms still breeding), and responded to minimal O2 supplmt'n.. Subjacent ascites with subsequent splinting and effusion would not likely cause an acute event? Wonder if She had a delayed hypersensitivity reaction? Is she atopic or a health care worker? Was the rectal probe covered with a latex sheath? She had a prior surgery - might have been sensitized at that time.  /tj <table width0%> <tr valign=top> <td> <td>"Elrod Darryl G MAJ 48 MDOS/SGOBO" <Darryl.elrod@LAKENHEATH.AF.MIL> Sent by: ob-gyn-l@obgyn.net 09/28/2005 03:18 PM Please respond to ob-gyn-l <td>                To:        Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>         cc:                 Subject:        RE: Opinions on laparoscopy (long)</table> Good news.  Her IVP was normal.  No extravasations from the bladder or ureter.  Both ureters clearly seen from kidney to bladder as well. I'm sure they could have told me as much from the CT I did a couple days ago, but there is something satisfying about seeing a full IVP films to show that all is well. So far, she has been afebrile and tolerating po for the last 24 hrs.   We may never really know what caused any of this.  Makes me wonder how her pelvic pain will be now! Glen ------------------------------------------------------ ------------------------------------------------------ ------------------------------------------------------ New this morning is her C diff is positive. I can't wait to dictate this discharge summary. ------------------------------------------------------ ------------------------------------------------------ We used to leave 1L of fluid or more in the pelvis for "floatation effect" ------------------------------------------------------ to avoid adhesion formation so i don't think leaving her a bit wet was an issue. ------------------------------------------------------- ------------------------------------------------------- had previously had laparoscopy for pelvic pain where they fulgurated ------------------------------------------------------- endometriosis. I had a rectal probe in the rectum and a sponge stick in the vagina to be able to locate these.  Blood loss was about 100ml. On POD 2 now, she became hypoxic with desats to the 80s on RA. O2 was added and she came back up to normal. At the same time she became tachycardic with HR to 130s.   EKG, CXR and KUB were orderd. EKG-sinus tach CXR-right pleural effusion KUB-dilated large bowel with all bowels apparently pushed to the midline, with presumptive diagnosis of ascites. -------------------------------------------------------- -------------------------------------------------------- Foley gets put in with 1000ml out, grossly infected and subsequently -------------------------------------------------------- grows out E coli.  Cipro started. BUN/Cr bump to 25/2.5  IVF changed and within a day renal function normalizes. Renal ultrasound normal.  Ascites confirmed.  Pt still is not passing flatus nor tolerating any clears. CT scan today shows clearance of pleural effusions, large amount of ascites but no dilated bowels or signs of abscess.   

Next message: Joanne Bulley, MD: "Re: Something Interesting"
Previous message: DMECNM@aol.com: "Fri: Creativity may pay off."
Maybe in reply to: Elrod Darryl G MAJ 48 MDOS/SGOBO: "Opinions on laparoscopy (long)"

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