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Re: Vaginal Cuff Evisceration- Follow up From: Andrew Folley (agfolley@hotmail.com) Mon Jun 27 15:59:53 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Robert J. Carpenter, Jr. MD: "Re: Incompentent Cervix?--->med-leg ramifications" Previous message: doctorjoe@aol.com: "Re: Vaginal Cuff Evisceration" In reply to: Gerald P. Rodríguez: "Re: Vaginal Cuff Evisceration" Thanks fo the input. I took her to surgery Saturday night. Decided on vaginal approach. I excised the cuff to get "fresh tissue" irrigated the pelvis with sterile water (there were a lot of clots up in the cul de sac but no obvious infection or abcess) and a gram of ancef and 5000 heparin ("magic potion") tried to reperitonealize with purse string closure and then did interrupted closure with 0-PDS. I also stuck in a JP drain through the posterior fonix below the bvaginal cuff site. I thought about using some 5-0 steel sutures with barb.... just joking. She denied doing squat thrusts on fire hydrants and said her sexual pracitces were no more abnormal that the average ob-gyn resident. I will let you know how she does over the next 6 months. I agree it must be sexual related to be getting these 2 recurrent cuff breakdowns. thanks again, andrew >From: "Gerald P. Rodríguez" <geraldpr@cybermesa.com> >Reply-To: ob-gyn-l@obgyn.net >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >Subject: Re: Vaginal Cuff Evisceration >Date: Mon, 27 Jun 2005 08:30:59 -0500 > >She is not falling on picket fences. Some sort of vaginal penetration >trauma is occurring and it may just "normal" intercourse. I would attempt >to repair it from below but I would want some reassurance that the pelvis >is not harboring a foreign body. Perhaps the larger question is what can >you do now so that this does not happen a third time. > >Gerald P. Rodríguez, M.D., FACOG >Santa Fe > >>----- Original Message ----- From: "Andrew Folley" <agfolley@hotmail.com> >To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net> >Sent: Monday, June 27, 2005 7:10 AM >Subject: Re: Vaginal Cuff Evisceration > >> >>Over the weekend I had a 23 yo woman come in to ER with pelvic and >>abdomianl pain acute onset with cramping and vaginal bleeding. She had >>had a hsyterectomy by my partner in December 2004. >>(Severe endomietriosis pelvic pain etc) I examined her and she had a 2 by >>3 cm. opening in her vaginal cuff at the site of closure. What is >>particularly bizarre is that she had a similar presentation in April about >>8 weeks previously. She had signs of acute abdomen then and was explored >>by surgery with large midline abdominal incision and found to have a >>"abdominal /vaginal " perforation or opening in cuff. It was repaired >>abdominally by her original GYN at that time. I could put 2 fingers into >>the cuff opening and visualize small bowel through tht vagina although it >>had not prolapsed through the cuff. WBC and Hb normal. he denies any >>unusual sexual practices. No durgs smoking, no steroids, no diabetes, >>weighs 130 pounds. >>What would you do now?? andrew >>> >> > Next message: Robert J. Carpenter, Jr. MD: "Re: Incompentent Cervix?--->med-leg ramifications" Previous message: doctorjoe@aol.com: "Re: Vaginal Cuff Evisceration" In reply to: Gerald P. Rodríguez: "Re: Vaginal Cuff Evisceration"

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