Re: Interesting puzzling case
From: R. Daniel Braun (rd.braun@gmail.com)
Thu Aug 31 12:28:35 2006
But cheap and effective.
On 8/31/06, art fougner, md <evsono@pipeline.com> wrote:
>
> 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
>
--
R. Daniel Braun
"The way to health is an aromatic bath and scented massage everyday".
Hippocrates
