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Re: hematoma From: =?Windows-1252?Q?Gerald_P._Rodríguez?= (geraldpr@cybermesa.com) Thu Nov 27 07:49:08 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R. Daniel Braun: "Re: GYN: hematoma" Previous message: Joe: "Re: hematoma" In reply to: Joanne Bulley, MD: "GYN: hematoma" Next in thread: R. Daniel Braun: "Re: GYN: hematoma" I would open this hematoma only if: 1) Pain becomes a real issue, or if 2) Becomes febrile or other findings suggesting the conversion of the hematoma to an abscess. Otherwise it's time to sit on your hands and squirm a bit. Gerald P. Rodríguez, M.D., FACOG Santa Fe >----- 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 5:23 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: R. Daniel Braun: "Re: GYN: hematoma" Previous message: Joe: "Re: hematoma" In reply to: Joanne Bulley, MD: "GYN: hematoma" Next in thread: R. Daniel Braun: "Re: GYN: hematoma"

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