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Re: R: Right tuboovarian absces after laparotomy for left tubovarian abscessFrom: Carlos Rubio (crubiol@meditex.es)Thu Mar 23 15:50:39 2000
Today the patient is much better, no pain at all, no fever (she never had it, even before the first laparotomy on the 2nd March), white blood count is 5600, no left deviation, Hb: 11.5, Negative for HIV test, waiting for tuberculine reaction test (tomorrow I will see). She had a scan today and the image is still there (I wish it was gone) 6 cm x 4 cm, but the echoes inside the cavities (2) looks like the abscess is getting organized (is the way we call it here in Spain). The vaginal examination taday reveals the mass on the right adnexae, but no pain at all. Patients feel fine, shitting and peeing well. she has been on IV antibiotics (clindamicine 900 mg/8h, and Gentamicin 80 mg/8h) for the last 4 days. I already know that her fertility was poor,(I already did a left anexectomy on the 2nd March) when I saw the second abscess on monday. Most likely her right tube is already destroyed. I am reluctant to open her up right now, first because she is getting better, second because If I open her and I find the right tuboovarian abscess probably could be difficult to conserve some healthy ovarian tissue. I hope the abscess will get organized and aseptic, get chronic, will wait for the endocervical swabs taken on manday, wait for the tuberculin test, wait for antituberculin antibodies, wait for antigonococial antibodies and wait for the evolution of the bclinical situation. I already precipitated in open her on the 2nd March when she presented with left lowe abdo pain with a anechoic mass on the left adnexa, no high white cells count, just only high VSG, and no fever (I really thought it was a torsioned ovaran cyst or haemorragic luteum cyst). Here in Spain we said that the best cuality of an Obstetrician is the patience (know how to wait). Probably I am not right, thats is why I am writing this, just to know other doctors opinion... All of us committ mistakes, ones more than others, noone is perfect, but I always try to do the best I can for my patients. Comments welcome, please
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