Re: Interesting puzzling case
From: R. Daniel Braun (rd.braun@gmail.com)
Thu Aug 31 07:15:21 2006
Ashley,
What is wrong with an upright PA Chest film to look for air under the
diaphragm? By two weeks any CO2 that was left from the laparoscopy will be
LOOOOOOOOOOOOOOOONG gone. Lot cheaper than repeating the CT Scan
Dan
On 8/30/06, D. Ashley Hill <dahmd@cfl.rr.com> wrote:
>
> This type of case will drive you nuts. Two weeks out is a little long
> for a GI injury to manifest, but there are case series that show up to
> 1/7 small bowel injuries will take up to 2 weeks to show up,
> particularly if the injury was from thermal damage. It might be
> worthwhile repeating the CT scan, always unpopular with patients. Is
> there a significant bandemia? According to a colorectal surgeon I know
> GI injuries often show elevated bands (note my lack of supporting
> evidence). If you have ruled out other sources of infection (pneumonia,
> cholecystitis, appendicitis, clostridium difficile) then you may have to
> re-scope her to look around, with the understanding that she may end up
> with a laparotomy. Don't leave us hanging, and good luck.
>
> Ashley
>
> At Wed, 30 Aug 2006, Joe Cutchin wrote:
> >
> >Watch her like a hawk. Don't want to miss bowel injury. I would imagine
> >by now though if she has bowel injury it would be manifesting itself
> >with more severe symptoms. Bottom line: I would feel more comfortable
> >examining her myself if I did the surgery. Joe C
> >
> >ENDODOK@aol.com wrote:
> >
> >> Interesting puzzling case:
> >>
> >> 39 yr old G2P2 (C/Sx2) underwent simple LSH for adenomyosis, discharged
> >> 4 hrs.post-op. Recuperation rapid. Awoke 2AM p.o. day 14, with
> >> epigastric and RUQ pain, and 2 diarrheal stools. No chills/ fever/
> >> anorexia/, nausea or vomiting. Pt has very long Hx. of "stomach
> >> problems", work-up by GI "delayed gastric emptying", Rx with Reglan
> and
> >> Zantac. Sx. occur a couple of times per year, slow response to above
> meds.
> >>
> >> Pt. lives 35 miles away, went to her local community
> >> hospital that evening as pain increasing. P/E totally negative- Vitals
> >> normal, abdomen soft, non-tender, no distention, no guarding, no
> >> rebound, BS wnl. Pelvic unremarkable- no mass/ induration / tenderness/
> >> local heat ( as one can find with a hot TOA). Hct 40%, WBC 19,000.
> >>
> >> Your thoughts??
> >>
> >> Glenn Bradley MD
> >>
>
> --
> D. Ashley Hill, MD
> Associate Director
> Department of Obstetrics and Gynecology
> Florida Hospital Family Practice Residency
> Medical Director, Loch Haven Ob/Gyn Group
> Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
> Orlando, Florida
>
--
R. Daniel Braun
"The way to health is an aromatic bath and scented massage everyday".
Hippocrates
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