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Gyn: Post LEEP infectionFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Fri Mar 28 20:26:55 2008
60 YO P2002, menopausal on continuous combined HRT had a low grade cytologic abnormality several years ago, and I did a LEEP and got atypia or something similar. She is thin and a bit more frail than average, from my vantage point. A recently pap came back as HGSIL or it might have been ASC-US, HR HPV positive (can't remember). Colposcopy was inadequate and I did a LEEP with CIN I, clear margins. At around 2 weeks postopertively, she saw a partner of mine on a Thursday with temp of around 101 to 102, and he put her on oral antibiotics. A couple of days later, on a Saturday, she called, still febrile/sick/weak/crying. Her exam was remarkable for a temp of 102, diffuse lower abdominal tendernes, a bit of a foul discharge, a tender uterus (hard to assess due to guarding) and no mass. The LEEP bed looked pretty normal to me. Her WBC was 13K, and an ultrasound done to rule out a pelvic abscess showed a 2 cm. exophytic mass on the uterus--either an abscess or hematoma. She improved over a few days on IV antibiotics, was sent home on oral ones, and came in a few days later with yeast, nausea, and just feeling crappy but with no fevers, etc. Her exam was benign save obvious yeast of the external genatalia, and her discharge was non foul. I chose to take her off antibiotics. A few days later she was better. Today, around a month after the surgery, she is close to normal and had a repeat ultrasound. The mass is now 1 cm., and her exam very benign. Would you ultrasound again? CT? Other? Clinically, I think that she is well and will be back to normal soon. Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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