Re: Gyn: Post LEEP infection
From: Ricardo Francalacci Savaris (rsavaris@hcpa.ufrgs.br)
Sun Mar 30 21:59:45 2008
After many years away from the list, here I am back writing
Gary it seems a case of PID post uterine manipulation (ok, it is not technically a PID, but you would treat as the it was)
The imagine seems to be a hydrossalpinx, at least that seems to be the most logical hypothesis. I would not do much.
Differential diagnosis is ovary, and this another story.
In addition, I would be more concerned about the HGSIL if it is AGUS, would be intersting to investigate the cervical canal and the endometrium.
Hope it helped.
Take care
Ricardo Savaris, MD, PhD
Associate prof. of OBGYN. UFRGS, Brazil
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Date: Fri, 28 Mar 2008 21:26:52 -0500 (CDT)
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From: garrys@mindspring.com (Garry E. Siegel, M.D.)
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To: OB-GYN-L@OBGYN.net
Subject: Gyn: Post LEEP infection
Message-ID: <200803290226.m2T2Qqe25535@mail.obgyn.net>
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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