Re: hematoma
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Thu Nov 27 19:51:50 2008
Agree with Joe, Steve, John:
Open a bit, whether sutures or over the hematoma, evacuate, irrigate,
and pack. Cover with antibiotics.
She'll feel better and get better sooner.
Garry
At Fri, 28 Nov 2008, Raymond Stephen wrote:
>
>I agree - the removal or cutting of a stitch is all it requires. There
>will be no active bleeding, as it is now more than a week since the
>original procedure, all that has happened is the haematoma formed
>immediately postoperatively, and is now liquefying and draining through
>whatever gap it can find. Be nice to your patient and help it along by
>opening a little more gap. That will make her feel so much better and
>allow spontaneous resolution. Antibiotic cover would be a good idea
>too.
>
>Steve Raymond
>Ph (03)62227898
>Cell 0438372395
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>vnellsch
>Sent: Friday, 28 November 2008 12:34 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: 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
>
>> 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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>
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--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
