Re: hematoma
From: vnellsch (vnellsch@eastex.net)
Fri Nov 28 06:47:22 2008
i think that what gerald rodriguez says is quite true, sit on your
hands and squirm a bit. in my litigious area, filled with predatory
lawyers, i know i do when a case doesn't go perfectly. verner nellsch,md
>----- 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 8:02 AM
Subject: Re: hematoma
> 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
