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Re: Residual uterine tissue after subtotal hysterectomy From: Gerald P. Rodríguez (geraldpr@cybermesa.com) Wed Dec 24 13:39:00 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Charlie Chambers: "Re: 4D ultrasound" Previous message: Joanne Bulley, MD: "Re: 4D ultrasound" The "5.9 X 3.7 X 3.0 cm" measurement--it that the "residual uterus" plus the " 'long cervix,' " or, is that just the "residual" uterus. If it's the latter then she had a "subtotal hysterectomy" in name only and probably has a lot of residual endometrium. I would first review the U/S films and if she has what I think she has (at lot of myometrium/endometrium), then I would do a careful D & C under an anesthetic to adequately evaluate the endometrium. Once assured that her endometrial status is OK, I would offer hormonally controlled bleeding vs. vaginal surgical approach to complete her "hysterectomy." I certainly would not offer further hormonal therapy until her endometrium is certified to be benign. Some "subtotal" hysterectomies are less subtotal then some. Gerald P. Rodríguez, M.D., FACOG Santa Fe >----- Original Message ----- From: "Garry E. Siegel, M.D." <garrys@mindspring.com> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net> Sent: Wednesday, December 24, 2003 12:55 PM Subject: GYN: Residual uterine tissue after subtotal hysterectomy > 39 YO P3103, old patient years ago, returned for a second opinion. > > 11/02 underwent subtotal hyst/BSO for fibroids, done with local good gyn > onc and regular gyn. Since then, she has had been on Premarin 1.25 mg. > daily for menopausal symptoms, but has bleed pretty much continously. > > Original gyn suggested OCPs; patient didn't try them. > Another gyn did exam, ECC (inflammed endocervical tissue), and while I > don't have records, the patient said the gyn said she only went in 2.5 > somethings--I assume cm. > > Her internist ordered a pelvic ultrasound, which showed a "long cervix" > and residual uterus 5.9 X 3.7 X 3.0 cm. > > Ideally, I would like to sample her endometrium, or even look at it with > a scope, but I'm none too keen on going up her cervix and into her > abdominal cavity! > > Thus, I've proposed to simply cycle her as if she were menopausal with a > uterus (she sort of is) with daily Premarin 1.25 mg, and Provera 10 mg. > for 12 days/month, and see how she responds. > > She is pretty much ready to have another surgery, but I've suggested the > above first. > > Any thoughts? > > Garry > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA > Next message: Charlie Chambers: "Re: 4D ultrasound" Previous message: Joanne Bulley, MD: "Re: 4D ultrasound"

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