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Re: hematomaFrom: Charles Bloom (cdsb@bellsouth.net)Thu Nov 27 05:35:41 2008
You said "Bright red watery blood actively draining." As long as she isn't actively BLEEDING, this is probably what you suspect, an organized hematoma that now needs to drain its serosanguineous component. Since her H&H are acceptable, I agree with your plan of watchful expectation and follow her H&H's. Despite her low WBC, if she had a left shift, I'd start some antibiotics. Happy Thanksgiving. Charles -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joanne Bulley, MD Sent: Thursday, November 27, 2008 7:24 AM To: Multiple recipients of list OB-GYN-L Subject: GYN: hematoma Happy Thanksgiving folks. 49yo G2P2 (babies were 9 & 11 pounds, if my recollection is correct, delivered easily & a long time ago) menses currently scant every 2-3 months, with intermittent hot flashes Rectocele repair 11/19/08 ER this AM, came in after she started gushing blood at home. At 5-6 days post op she says she was feeling hot & cold, not sure if it was just the hot flashes. Temp in 99's never over 99.8. Sore in rectal area. She did not complain of that, but answered when asked. BMs uncomfortable. Exam: repair intact, palpable hard mass upper portion of repair extending along ischio-rectal area more to right. Bright red watery blood actively draining. Preop Hgb/Hct: 13.5/38.9 WBC 5.23 Today: 11.1/32.0 WBC 6.42 CT scan pending with contrast. Presumed diagnosis: hematoma filling ischio-rectal area & now draining through suture line. Last one of these I saw was with the post partum vaginal hematomas. I know if I open the chance of actually finding the bleeder is nearly nil and could increase bleeding. Any thoughts on management welcome. Possibly go to OR and pack it under anesthesia (with or without opening). Not eager to open it and have tons of blood but no ability to find the actual bleeder and end up losing more blood. Should have CT report in about 2 hours. Gotta let the contrast get down there to discern bowel from hematoma. Thanks for any thoughts!
-- Joanne Bulley, MD solo gyn Keene, NH
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