Re: GYN: Hemoperitoneum
From: art fougner, md (evsono@pipeline.com)
Fri Feb 5 07:59:08 1999
last woman i saw with a ruptured spleen was interesting in that she also
was using an IUD and was late with her menses. she presented to the er
in shock and had a + cul de sac tap. on further questioning, she gave a
history that one week prior to presentation, her boyfriend had hit her
in the upper back with a louisville slugger. at surgery, a ruptured
spleen was found and successfully treated with a mesh. was an
interesting case.
art
At Fri, 5 Feb 1999, Braun, R. Daniel wrote:
>
>Of the two ruptured spleens that I have seen neither one had abdominal pain.
>I have seen many (at least 10) ruptured ectopics over the years who had
>>1500 cc's of blood in their bellies and no pain. If it is a sudden loss of
>fresh blood, no pain is a common finding. If it has been leaking for a long
>time, pain is very common.
>Dan
>
> -----Original Message-----
> From: Gail Waldby, MD [SMTP:gwaldby@willinet.net]
> Sent: Friday, February 05, 1999 7:29 AM
> To: Multiple recipients of list
> Subject: Re: GYN: Hemoperitoneum
>
> I was taught that blood in the belly is painful. That is why
>patients
> with ruptured spleens and liver lacerations have pain.
> Gail Waldby, MD
> Huron Clinic SD
> General Surgery
>
> "Garry E. Siegel, M.D." wrote:
> >
> > I inherited an acute abdomen from the ER this week, a 26 YO P3003,
>s/p
> > TL, who at 2200 hours had the sudden onset of lower abdominal
>pain, 30
> > minutes after intercourse. She lived with it through the night,
>and
> > came to the ER at about 9 AM. Her abdomen (per the good ER MD)
>was
> > rigid, her Hct was 38, and she was clinically stable but needed
>pain
> > meds. A general surgeon was called first, and a CT ordered/done.
>It
> > showed lots of free fluid, not the density of blood (Houndsfield
>units
> > or somesuch), and a 6 cm. retrouterine solid mass.
> >
> > Well, then I got the call, and the woman did have a tender
>abdomen,
> > lessened somewhat by the pain meds, and the suggestion of a
>posterior
> > mass. The ultrasound showed the same.
> >
> > I scoped her later, and *as her history would suggest*, she had
>ruptured
> > an ovarian cyst (it seemed to be a Corpus Luteum cyst), and had
>600 cc
> > of blood and clots, including a big wad of clot in the cul de sac.
> >
> > When I ran into the surgeon later, I commented that the blood in
>her
> > belly is what hurt her, and he said that blood doesn't hurt!
> >
> > Well, fellow gynecologists, I was raised to believe that blood in
>the
> > peritoneal cavity is an irritant, and is the cause of pain. The
> > surgeon, a few years older than me, was raised with the exact
>opposite
> > idea.
> >
> > Does anyone have any comments?
> >
> > Garry
> >
> > --
> > Garry E. Siegel, M.D., FACOG
> > Private Practice
> > Roswell, Ga.
--
art fougner, md
SonoScan/Genetic Sciences
forest hills, ny
evsono@pipeline.com
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