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Re: Vulvar haematoma From: Anna Meenan, MD (annam@uic.edu) Sun Jan 22 13:24:46 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Eberhard Lisse: "Re: Vulvar haematoma" Previous message: zygote@icsi.net: "Re: Breech Trail" In reply to: Dr Eberhard Lisse: "Re: Vulvar haematoma" Next in thread: Dr Eberhard Lisse: "Re: Vulvar haematoma" Reply: Dr Eberhard Lisse: "Re: Vulvar haematoma" What sort of diet do the people in your neck of the woods consume, El? The reason I ask is that I am remembering back to about 1978, when Dr. Denis Burkitt came to speak to my medical school class about the benefits of fiber in prevention of disease. In addition to naming his lymphoma, he had done a lot of research on the prevalence of various diseases in Africa, including coronary artery disease, diabetes, cholecystitis, hemorrhoids, and appendicitis, and of course, constipation, and had come to the conclusion that it was a traditional high-fiber African diet that prevented these diseases which he saw rareky, if ever, in his travels in Africa. I vividly recall him showing slides of bowel movements left on the side of the road by local folks, pointing out how soft and bulky they were (thank goodness it wasn't a lunchtime lecture). He once said, "America is a constipated nation.... If you pass small stools, you have to have large hospitals." Anyway, I just wondered what the local diet is like now, if constipation is such an endemic condition. -- Anna Meenan, MD At Sat, 21 Jan 2006, Dr Eberhard Lisse wrote: > >The mass? Constipated ascending colon. (Fairly endemic here, by the way, >due to diet). > >They can hurt you more... > >el > >on 1/21/06 6:24 AM D. Ashley Hill said the following: >> At Fri, 20 Jan 2006, DoctorJoe@aol.com wrote: >> >>>In a message dated 1/20/06 2:13:24 PM, el@lisse.NA writes: >>> >>>>Next Diagnostic Step? >>>> >>>>Next Therapeutic Step? >>>> >>>Laparotomy for drainage of retroperitoneal hematoma? >>> >>>Joe P. >> >> My vote, also. Here is my thinking, given the story thus far: I don't >> think this is a a straightforward vulvar hematoma, which is an >> intrafascial hematoma that will tamponade itself (unless the vulvar skin >> ruptures) since Colles' fascia limits the spread. A paravaginal >> hematoma is suprafascial but can be quite large. However, a paravaginal >> hematoma should not produce a large mass like El described going up >> towards the liver. This sounds like a retroperitoneal hematoma, >> particularly since the belly is fairly soft but there is shock and a >> hard mass up the right paracolic gutter. I don't think further >> diagnostic evaluation outside of a Bard-Parker is necessary, given the >> clinical situation. >> >> Since the patient is in shock, I would consider a set of coag studies, >> transfusion as indicated, then evacuation of the hematoma and possible >> unilateral hypogastric artery ligation if still bleeding. Opening up >> the broad ligament into the retroperitoneum (similar to how one would >> look for the ureter during an abdominal hysterectomy) allows access to >> the hypogastric vessels and the hematoma. I would leave the peritoneum >> over the hematoma open after evacuation, and place a drain. >> >> Well, what's the rest of the story?! Probably something weird like >> Ascaris of the broad ligament :) Thx, >> >> -- >> D. Ashley Hill, MD >> Associate Director >> Department of Obstetrics and Gynecology >> Florida Hospital Family Practice Residency >> and Loch Haven Ob/Gyn Group >> Orlando, Florida Next message: Dr Eberhard Lisse: "Re: Vulvar haematoma" Previous message: zygote@icsi.net: "Re: Breech Trail" In reply to: Dr Eberhard Lisse: "Re: Vulvar haematoma" Next in thread: Dr Eberhard Lisse: "Re: Vulvar haematoma" Reply: Dr Eberhard Lisse: "Re: Vulvar haematoma"

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