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Re: hematoma From: vnellsch (vnellsch@eastex.net) Thu Nov 27 06:32:25 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: hematoma" Previous message: Charles Bloom: "Re: hematoma" In reply to: Joanne Bulley, MD: "GYN: hematoma" Next in thread: Joanne Bulley, MD: "Re: hematoma" Reply: Joanne Bulley, MD: "Re: hematoma" Reply: Raymond Stephen: "Re: hematoma" i'll tell you, joanne, when i have had cases like these, i have found it best to assure drainage by taking out a few sutures, then giving something like levaquin p.o., monitoring the cbc, and restraining myself from exploring unless the hct. gets too low. sometimes there is pressure from the patient and family to do something, but i think it is best to not explore unless you have a good reason. if they act litigious, i get a surgeon involved, who has always agreed with the course of action. of course, if they go down the road to dr. wonderful, who promptly takes them to surgery, then tells them that he/she saved their life, you are in a mess. good luck. vnellsch >----- Original Message ----- From: "Joanne Bulley, MD" <islesannie@gmail.com> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net> Sent: Thursday, November 27, 2008 6:24 AM 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 Next message: Joanne Bulley, MD: "Re: hematoma" Previous message: Charles Bloom: "Re: hematoma" In reply to: Joanne Bulley, MD: "GYN: hematoma" Next in thread: Joanne Bulley, MD: "Re: hematoma" Reply: Joanne Bulley, MD: "Re: hematoma" Reply: Raymond Stephen: "Re: hematoma"

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