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Re: Interesting puzzling case- part 2 (LONG) From: Lynn Montgomery, MD (apgar10@qwest.net) Thu Aug 31 07:42:09 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Interesting puzzling case" Previous message: R. Daniel Braun: "Re: Interesting puzzling case" In reply to: ENDODOK@aol.com: "Re: Interesting puzzling case- part 2 (LONG)" Next in thread: Andrew Folley: "Re: Interesting puzzling case- part 2 (LONG)" At this point, you have fever of unknown origin. Culture (resin bottles given some antibiotic therapy) and begin broad spectrum antibiotic coverage. If continues to spike with elevated WBC after 48 hours, then repeat CT or T-99 scan. Certainly bowel injury is a consideration, but wouldn't one expect more of an issue with ileus this far into it. I may have missed it, but what about the chest x-ray. Lynn -- Lynn D. Montgomery, M.D. Obstetrics & Gynecology, Maternal-Fetal Medicine The Birth Center/Rocky Mountain Women's Health 1211 S. Reserve St. Missoula, Montana, 59801 406-549-0978 fax 406-549-0987 e-mail: apgar10@qwest.net _____ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ENDODOK@aol.com Sent: Wednesday, August 30, 2006 6:36 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Interesting puzzling case- part 2 (LONG) Thank you all who responded re the initial communication on this case. Now part 2: Following the initial ER evaluation on day one of sx., pt. and her RN mother inclined to believe " a flare-up" of her long standing "stomach problem". The following late afternoon, pt. called and declared nothing had changed... pain the same, no anorexia, nausea, vomiting, distention, chills, fever, bleeding. 2 loose stools that day, moderate headache. Pt agreed to drive to my office for evaluation the following AM. Saturday AM pt seen. No change in history. P/E negative... afebrile, BP and pulse normal, no nausea or vomiting, no further diarrhea, no chills or fever. Abdominal exam = soft, no distention, Incisions healed, no tenderness/ guarding/ rebound. BS normal. Pelvic = no tenderness/ induration/ masses or warmth. Hospital UTZ = Small amount cul-de sac fluid. Hct 35%; WBC 24,000. Emperically started on Cipro ( something is infected but where??). Pt developed fever 101-103 during that night, I am called in early AM, immediately direct pt to our hospital facility. On admission, Hx. slightly changed -- Abdominal pain now at level of umbilicus. Temp 102. RN mom had administered a Harris flush for alleviation of "gas" ( no effect) and pt had on her own taken some MOM because of no BM for 2 days, resulting in 3 diarrheal stools while in transit from home. Abdominal and pelvic exam exactly as before... totally negative!! Hct on admission 35%, WBC 24,000. Your management thoughts?? JGB Next message: art fougner, md: "Re: Interesting puzzling case" Previous message: R. Daniel Braun: "Re: Interesting puzzling case" In reply to: ENDODOK@aol.com: "Re: Interesting puzzling case- part 2 (LONG)" Next in thread: Andrew Folley: "Re: Interesting puzzling case- part 2 (LONG)"

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