Re: Interesting puzzling case
From: art fougner, md (evsono@pipeline.com)
Thu Aug 31 10:20:09 2006
Erect Chest Film? Dan, that's SO 20th Century LOL.
Art
At Thu, 31 Aug 2006, R. Daniel Braun wrote:
>
>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
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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