Re: hematoma
From: vnellsch (vnellsch@eastex.net)
Fri Nov 28 06:44:32 2008
i swim in waters filled with sharks here near houston. even long term
patients who
are in a painful, messy post op condition can have their heads turned by dr.
wonderful,
and then his/her old college room mate, i.b. shark, j.d. so, i try to think
everything out,
to either not get bitten, or not bleed when i do. verner nellsch
>----- Original Message -----
From: "Joe" <forcep@intercom.net>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net>
Sent: Thursday, November 27, 2008 8:46 AM
Subject: Re: hematoma
> I agree with Charles. Start the antibiotics and I LOVE packing in these
> situations for short period of time , 2-3 days. Joe C
>> Thanks to Charles and to "vnellsch" (I would appreciate it of you would
>> you sign with your name)
>>
>> I have 23 years with this patient and litigiousness is not in the wings
>> at all.
>>
>> WBC: 68% neutrophils, no left shift
>> PT 10.2 INR 0.97
>> aPTT 29.8
>>
>> But antibiotics are not a bad idea even without leukocytosis, since the
>> blood sure is a great culture medium as we all know.
>>
>> I should get a call from the hospital shortly about the CT scan -
>> hopefully she is in the scanner now.
>>
>> I will probably also call the other gyn in town for his thoughts. I get
>> along very well with him and he happens to be on call for their group
>> today.
>>
>> Would others open just to let it drain?
>> Would you put in any packing?
>>
>> At Thu, 27 Nov 2008, vnellsch wrote:
>>
>>> i'll tell you, joanne, when i have had cases like these, i have found it
>>> best to
>>> assure drainage by taking out a few sutures, then giving something like
>>> levaquin p.o.,
>>> monitoring the cbc, and restraining myself from exploring unless the
>>> hct.
>>> gets too low.
>>> sometimes there is pressure from the patient and family to do something,
>>> but
>>> i think it
>>> is best to not explore unless you have a good reason. if they act
>>> litigious,
>>> i get a surgeon
>>> involved, who has always agreed with the course of action. of course, if
>>> they go down
>>> the road to dr. wonderful, who promptly takes them to surgery, then
>>> tells
>>> them that he/she saved
>>> their life, you are in a mess. good luck. vnellsch
>>>
>>>>> ----- Original Message -----
>>>>
>>> From: "Joanne Bulley, MD" <islesannie@gmail.com>
>>> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net>
>>> Sent: Thursday, November 27, 2008 6:24 AM
>>> Subject: GYN: hematoma
>>>
>>>> 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
>>>>
>>
>> --
>> Joanne Bulley, MD
>> solo gyn
>> Keene, NH
>>
>
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