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Re: GYN: hematoma From: R. Daniel Braun (rd.braun@gmail.com) Thu Nov 27 08:08:05 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Eberhard W Lisse: "Re: hematoma" Previous message: =?Windows-1252?Q?Gerald_P._Rodríguez?=: "Re: hematoma" In reply to: Joanne Bulley, MD: "GYN: hematoma" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: GYN: hematoma" Your active bleeding has probably stopped a long time ago. All blood coming out now will probably be clots and serum etc. I think that opening, irrigating and then packing the vaginal wall down against the area(Intravaginal pack) would be the best way. Dan On Thu, Nov 27, 2008 at 7:23 AM, Joanne Bulley, MD <islesannie@gmail.com>wrote: > Happy Thanksgiving folks. > > 49yo G2P2 (babies were 9 & 11 pounds, if my recollection is correct, > delivered easily & a long time ago) > menses currently scant every 2-3 months, with intermittent hot flashes > > Rectocele repair 11/19/08 > > ER this AM, came in after she started gushing blood at home. > > At 5-6 days post op she says she was feeling hot & cold, not sure if it > was just the hot flashes. Temp in 99's never over 99.8. Sore in rectal > area. She did not complain of that, but answered when asked. BMs > uncomfortable. > > Exam: repair intact, palpable hard mass upper portion of repair > extending along ischio-rectal area more to right. Bright red watery > blood actively draining. > > Preop Hgb/Hct: 13.5/38.9 WBC 5.23 > Today: 11.1/32.0 WBC 6.42 > > CT scan pending with contrast. > > Presumed diagnosis: hematoma filling ischio-rectal area & now draining > through suture line. > > Last one of these I saw was with the post partum vaginal hematomas. > > I know if I open the chance of actually finding the bleeder is nearly > nil and could increase bleeding. > > Any thoughts on management welcome. > Possibly go to OR and pack it under anesthesia (with or without > opening). > Not eager to open it and have tons of blood but no ability to find the > actual bleeder and end up losing more blood. > > Should have CT report in about 2 hours. Gotta let the contrast get down > there to discern bowel from hematoma. > > Thanks for any thoughts! > > -- > Joanne Bulley, MD > solo gyn > Keene, NH > -- R. Daniel Braun, MD FACOG(L) ABMP CMTh Professor Emeritus Dept. of Obstetrics and Gynecology Indiana U. School of Medicine R. Daniel Braun "Science without Religion is LAME; Religion without Science is BLIND" Einstein 1941 Next message: Dr Eberhard W Lisse: "Re: hematoma" Previous message: =?Windows-1252?Q?Gerald_P._Rodríguez?=: "Re: hematoma" In reply to: Joanne Bulley, MD: "GYN: hematoma" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: GYN: hematoma"

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