Re: Postop problems--help appreciated (long)
From: amehc (amehc@ez-poa.com.br)
Sat Jul 20 19:21:21 2002
allow your GI friend make some extra bucks...
Ricardo Savaris, MD
Brazil
>----- Original Message -----
From: "Garry E. Siegel, M.D." <garrys@mindspring.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.medispecialty.com>
Sent: Saturday, July 20, 2002 1:50 AM
Subject: OB: Postop problems--help appreciated (long)
> 28 YO P1011 (now) induced on 7/15 due to 41 weeks. Induction started at
> 0700 with Pitocin, AROM. After epidural, at around 1300, found to be
> breech (I'm embarrassed) and thus underwent a primary low transverse
> section uneventfully.
>
> Postop, she has never been febrile, but was distended on day 1 (postop,
> i.e. 7/16) and day 2, and complained of pain with walking in her
> abdomen, back. Her abdomen was distended, hypoactive bowel sounds, no
> flatus, and she was given a suppository. On 7/18, postop3, seen by my
> partner who altered pain meds (Oxycontin every 12 hours, po Darvocet, IV
> Toradol and IVF begun).
>
> This AM, when I saw her, she looked fair, same complaints, but to my
> observatoin (I hadn't seen her in 48 hours), her abdomen was less
> distended and she still was hypoactive (bowel sounds). She was having
> no nausea and no flatus, and I thus ordered an enema, checked her CBC
> and metabolic panel--WBC less than 10K, serum potassium a bit low at
> 3.6. I increase her IVF to add potassium, and reassessed this PM at
> which time she looked a bit better.
>
> At 10PM the nurse called--the patient wants a GI consult!
>
> I believe that this is a garden variety ileus, and she will improve.
> This patient isn't the hardiest, as she was a bit below average in pain
> tolerance in early labor and with a miscarriage last year (in my office
> on 9/11/01 as the World Trade Center was collapsing!).
>
> I do not think there is a subtle bowel injury or hematoma in the absence
> of a fever or white count, and, sheesh, she's been eating for a couple
> of days.
>
> Any thoughts?
>
> Garry
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
