Re: Postmenopausal pelvic free fluid
From: Andrew Folley (agfolley@hotmail.com)
Wed May 9 12:13:30 2007
Culdecentesis is a wonderful tool that anyone 50 and over will still have in
their armamentarium.
>From: garrys@mindspring.com (Garry E. Siegel, M.D.)
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Postmenopausal pelvic free fluid
>Date: Tue, 8 May 2007 20:57:18 -0500
>
>Culdocentesis?
>
>When is the last time anybody did one of those?
>
>I think that the likelihood that she has something bad is low.
>
>Another case:
>
>85 YO P1001 in the hospital from assisted living for
>"dwindles"--abnormal Na+, etc. She is spry but a bit confused.
>
>Renal ultrasound saw a bit of fluid in the endometrial cavity.
>Pelvic ultrasound, transabdominal, saw the same. She was too honery for
>a transvaginal scan.
>Her exam was normal (hospital bed), and I sent a pap.
>
>Any thoughts?
>
>Garry
>
>PS--has had midline laparotomy years ago for something--patient and
>daughter simply don't know, but the daughter thinks that she only has
>1/2 of one ovary. She is not bleeding, and is NED for some type of
>bladder cancer.
>
>Garry
>
>At Tue, 08 May 2007, Andrew Folley wrote:
> >
> >I am not certain what the significance of peritoneal fluid would be in
>this
> >lady??? I would be inclined to wait and watch recheck echo in 3 to 6
>months
> >or at most do an office culdecentesis looking at the fluid for cytololgy
>and
> >protein level etc. It seems like laparoscopy might be doing too much at
>this
> >point. agf
> >
> >>From: AllanHo@aol.com (Allan)
> >>Reply-To: ob-gyn-l@obgyn.net
> >>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> >>Subject: Postmenopausal pelvic free fluid
> >>Date: Tue, 8 May 2007 17:46:34 -0500
> >>
> >>What would you do?
> >>
> >>60 yo P3 menopausal since age 45. New patient to me 3 weeks ago with no
> >>specific complaints. Had some left sided tenderness during bimanual
> >>exam. Transvaginal ultrasound showed free fluid in cul de sac. (Uterus
> >>was small. Ovaries were not seen.) Largest pocket 2x2x2cm. CBC, TSH,
> >>CEA, CA125, Liver & renal function tests were all normal. Chest x ray,
> >>CT abdominal & pelvis were non-contributory. Guaiacs were negative.
> >>Colonoscopy was negative. Same amount of pelvic free fluid in CDS three
> >>weeks later. Patient is asymptomatic.
> >>
> >>I am thinking about doing a culdocentesis, but also feel that going
> >>directly to laparoscopy may yeild more information and avoid the
> >>possibility of vaginal contamination of the fluid for culture. Thanks
> >>in advance for your input.
> >>
> >>--
> >>Allan
> >>Solo practice
> >>Southwest, PA
> >
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>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
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