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Re: hematoma From: Joe (forcep@intercom.net) Thu Nov 27 07:44:19 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: =?Windows-1252?Q?Gerald_P._Rodríguez?=: "Re: hematoma" Previous message: DoctorJoe@aol.com: "Re: Subject: running out of lemons" In reply to: Joanne Bulley, MD: "Re: hematoma" Next in thread: vnellsch: "Re: hematoma" Reply: vnellsch: "Re: hematoma" I agree with Charles. Start the antibiotics and I LOVE packing in these situations for short period of time , 2-3 days. Joe C > Thanks to Charles and to "vnellsch" (I would appreciate it of you would > you sign with your name) > > I have 23 years with this patient and litigiousness is not in the wings > at all. > > WBC: 68% neutrophils, no left shift > PT 10.2 INR 0.97 > aPTT 29.8 > > But antibiotics are not a bad idea even without leukocytosis, since the > blood sure is a great culture medium as we all know. > > I should get a call from the hospital shortly about the CT scan - > hopefully she is in the scanner now. > > I will probably also call the other gyn in town for his thoughts. I get > along very well with him and he happens to be on call for their group > today. > > Would others open just to let it drain? > Would you put in any packing? > > At Thu, 27 Nov 2008, vnellsch wrote: > >> 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 >>> > > -- > Joanne Bulley, MD > solo gyn > Keene, NH > Next message: =?Windows-1252?Q?Gerald_P._Rodríguez?=: "Re: hematoma" Previous message: DoctorJoe@aol.com: "Re: Subject: running out of lemons" In reply to: Joanne Bulley, MD: "Re: hematoma" Next in thread: vnellsch: "Re: hematoma" Reply: vnellsch: "Re: hematoma"

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