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Re: TOA and HIVFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Fri Mar 26 15:21:46 2004
At Fri, 26 Mar 2004, Dr. Ainsworth wrote: > >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. Procrastaning on I.V. antibiotics is usaully O.K but I have also had cases that crashed more than a week latter and end up with ARDS and DIC, so there is still something to be said for a hyst and a wide open vault while the patient is still stable. This could still be bowel, is her appendix gone?
--
Take care, John
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