Re: Interesting puzzling case
From: D. Ashley Hill (dahmd@cfl.rr.com)
Thu Aug 31 13:49:19 2006
I'm sure it's the same at your hospitals, but at mine you always get
"chest x-ray normal, suggest CT or MRI (or whatever additional test) to
confirm." Darn radiologists!
Ashley
At Thu, 31 Aug 2006, R. Daniel Braun wrote:
>
>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
>
--
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
