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TOA and HIVFrom: Dr. Ainsworth (ainsron@sbcglobal.net)Fri Mar 26 09:16:43 2004
42 yo patient, known HIV positive, admitted through ER with sepsis and pelvic mass, blood cultures positive for E.coli, cervical cultures - normal vaginal flora. Placed on triple antibiotics on admission by Hospitalist. Two days into therapy, CT scan showed a nonspecific pelvic mass, Sonogram the next day showed a 13x9x9 cm pelvic mass. When I examined her the same day she had a very obvious pelvic mass, palpable above the pelvic brim, very tender. No free fluid on the sonogram. She is now still symptomatic with pelvic pain, decreased abdominal tenderness, afebrile, WBC has come down from 26,000 on admission with a marked left shift, now 14,400 with no bands. Where would you go from here? 1- ultrasound or CT guided drainage of the mass 2- OR for vaginal drainage of mass / colpotomy 3- OR for Abdominal drainage of mass 4- OR for TAH/BSO My feeling is that she is clinically stable enough at this time for definitive surgical treatment and to approach it abdominally with plans to back off and simply drain it if there is too much phlegmon to safely remove it.
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