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Interesting cesarean sectionFrom: ainsron@msn.comTue Mar 20 14:35:56 2001
Yesterday I had a 34 week patient who was admitted over the weekend with abdominal pain, found stones on a sonogram of her gallbladder, elevated WBC with left shift. Wasn't getting better with NPO, continued to have N&V, abdominal pain, LFTs were slightly elevated, in spite of 48 hours of Cefotetan. General surgeon consulted and felt that she had acute cholecystitis, which I felt also, and that she needed surgery, which I also agreed with. Important history is that she had closure of gastroschesis as a infant, "big" scar from her pubis to her sternum. He wanted to try a lap chole by open laparoscopy, I wasn't to thrilled with the idea, but assisted him and we were unsuccessful because of adhesions. Ended up making a very large transverse upper abdominal incision and chasing adhesions forever. Finally after mobilizing her entire small and large bowel we were able to get to the gallbladder, and remove it. It actually looked more like we had a bowel obstruction, because there were multiple loops of dilated bowel with lots of narrowed areas due to adhesions. So even if we operated on her for the wrong reason, we did the right operation. Unfortunately, because of all of the edema and third spacing, there was no way to return her bowel to its rightful position. What to do? Never having faced this situation before, we decided that the best solution was to do a hysterotomy and deliver this 34 weeker, which I did through a classical incision. Even then, closure was a very "tight squeeze." Anyone faced a similar situation before? Any other alternatives we could have tried?
-- Ronald E. Ainsworth, MD
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