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Re: TOA and HIV From: Larry Glazerman (l.glazerman@rcn.com) Fri Mar 26 20:46:26 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "FRI: Humor" Previous message: Garry E. Siegel, M.D.: "Re: Prophylactic antibiotics at csection" In reply to: Garry E. Siegel, M.D.: "Re: TOA and HIV" If it's truly a unilateral TOA at the time of surgery, I've seen quite a few of them improve with a unilateral S/O -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Friday, March 26, 2004 9:30 PM To: Multiple recipients of list OB-GYN-L Subject: Re: TOA and HIV Gosh, I'm thinking to continue her on antibiotics, and if a CT directed drainage can be done and a catheter left in, then she might well improve without a laparotomy. Larry, I'm fascinated that you would do this via the lapscope. Tell us more. My gut says that if she needs surgery, she needs to have a TAH BSO. Garry At Fri, 26 Mar 2004, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. wrote: > >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 > -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: Joanne Bulley, MD: "FRI: Humor" Previous message: Garry E. Siegel, M.D.: "Re: Prophylactic antibiotics at csection" In reply to: Garry E. Siegel, M.D.: "Re: TOA and HIV"

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