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urinary obstructionFrom: Elrod, Darryl G Maj 48 MDOS/SGOBO (Darryl.elrod@LAKENHEATH.AF.MIL)Tue Mar 13 06:02:43 2007
You know I'm feeling like I'm just full of interesting cases these days, which usually would be a good thing, but now I'm getting a bit annoyed. 24 yo G1p1 with secondary infertility and pelvic pain/dysmenorrhea underwent a diagnostic laparoscopy with me a week ago. Two trocar incisions, one small peritoneal biopsy in the posterior cul-de-sac of the only thing close to resembling endometriosis (it wasn't), 20 minutes tops. Otherwise no pathology seen. Pt presented 2 days after surgery with nonspecific abdominal pain and distension. Acute abdominal series showed nonspecific bowel gas pattern. Labs including UA, CBC and metabolic panel were normal. Pt was discharged. Pt presented at postop day 6 with more distension and pain. Acute series showed an ileus. The bladder was cathed for a specimen and drained 2 (two) liters of urine. On admission patients BUN was 74 and creatinine was 7.4. After bladder drainage the creatinine was down to 1.6. The only known medical condition with this patient is currently untreated rheumatoid arthritis. She had been on methotrexate, humera (sp?) and steroids but stopped all 9 months ago. She does report a history of multiple UTIs as a child and adult, but no problems with constipation. She does have dyspareunia nearly always. Our plan so far has been foley catheter drainage for 7-10 days with prophylactic antibiotics. The urologist is going to do a cystogram today to evaluate for possible bladder injury during laparoscopy and will do a VCUG at 7-10 days to look for reflux. NPO for now until she begins to pass flatus again. Any thoughts on workup, management or differential? Glen //SIGNED// D. Glen Elrod, Maj., USAF, MC Obstetrician/Gynecologist Chief of Obstetrics 48 MDOS/SGOBO RAF Lakenheath, England Telephone DSN: 314-226-8130 Comm: +44 (0) 1638 52 8130 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this e-mail and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This e-mail message including any attachments is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any questions pertaining to disclosure should be directed to the privacy officer.
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