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Re: Ob: Cornual Ectopic From: Garry E. Siegel, M.D. (garrys@mindspring.com) Thu Aug 28 20:37:02 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R. Daniel Braun: "Re: Update on breech didelphyic" Previous message: DoctorJoe@aol.com: "Re: My case report can beat up yours" In reply to: Atkinson, Samuel M, Jr: "Re: Ob: Cornual Ectopic" Dear all: Great comments, and I did actually consider how to do her hysterectomy. The MFM was certain of the location, so no more imaging was deemed necessary. I saw her on Tuesday at 5 PM, and due to logistics, surgery was planned for Thursday AM. On Wednesday at 1 PM, in preop, she had a syncopal episode without pain and was taken to the ER where she had a benign exam per the ER MD and a stable hematocrit. Surgery was thus moved up to 5 PM Wednesday. My thinking as of Tuesday PM when scheduling it: I had a vaginal hysterectomy in residency on a woman with a chronic ectopic (this was before widespead HCG levels were available) and remember how bad it was. While she would have been a great candidate if not pregnant, I didn't feel like doing this where you couldn't see her pelvis. So, if you need visualization for a TVH candidate, and LAVH would work? Well, I was a bit reluctant to find out how each cautery line/pedicle would act, given the increased vascularity. Thus, I did a TAH, and she indeed had an unruptured cornual ectopic on the side that she had the S and O. There was around 100 ml. of old blood in the pelvis, and the pedicles on that side (back bleeders) were quite vascular. Garry Joe--genetic work up? I saw her for the first time Tuesday PM, as one of my partners (out of town) had seen her last week, so I didn't delve into that at all. At Wed, 27 Aug 2008, Atkinson, Samuel M, Jr wrote: > >I published a paper in So Med Journal Feb 1974 entitled "Vaginal >Hysterectomy: The Ideal Abortion in Multiparous Patients " VOL 67 (2) p >134-137. It was preceded by a favorable commentary on page 132. >In summary, the pregnant uterus is easier to remove than the non >pregnant one as the tissues are softer and more malleable. Of course, >this was in the dark ages(Pre laparoscope)! I suspect that laparoscopic >may be bloodier with the use of clips, cautery or harmonics on a >pregnant uterus. Of course, you can't empty the corneal pregnancy as >you can the normal Intrauterine one . >sAm > >-----Original Message----- >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of >rmodugno@aol.com >Sent: Tuesday, August 26, 2008 9:09 PM >To: Multiple recipients of list OB-GYN-L >Subject: Re: Ob: Cornual Ectopic > >LAVH > >Robert Modugno MD MBA FACOG >Sylva, NC > >-----Original Message----- >From: Garry E. Siegel, M.D. <garrys@mindspring.com> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net> >Sent: Tue, 26 Aug 2008 6:09 pm >Subject: Ob: Cornual Ectopic > >43 YO P2022, relatively new patient to the practice, seen by partners >but due to vacation, office rotation, comes to my attention. She and >her husband seem reasonable and quite intelligent. > >2 term SVDs, children 3 and 6, both severly autistic (her words), and >two spontaneous first trimester losses. > >HCG yesterday 17K, and ultrasound today with MFM is suggestive if not >diagnostic of a cornual pregnancy. > >She has had a laparotomy for a unilateral S and O at age 16 ("large >cyst") and a subsequent laparoscopy years ago for adhesions. > >Methotrexate offered and declined due to toxic chemicals, long term >effects, etc. Clearly, the two autistic children weigh into decision >making in terms of exposure to "stuff." > >Her exam is benign, 8 week size non-tender uterus. She is thin and has >a low transverse skin incision. > >She requests hysterectomy. > >What say you? > >If you do it, how? > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: R. Daniel Braun: "Re: Update on breech didelphyic" Previous message: DoctorJoe@aol.com: "Re: My case report can beat up yours" In reply to: Atkinson, Samuel M, Jr: "Re: Ob: Cornual Ectopic"

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