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need help with weird case.From: mark decker (mdecker@nconnect.net)Fri Apr 26 21:11:30 1996
patient is in late twenties. had patvh last fall. saw me for severe dyspareunia and pelvic pain. scoped her and found a low grade infection right at the cuff with a trapped bowel epiploacae in the vaginal cuff. wide enough adhesive issue we did a lap to free it up to avoid injury of the densely adhered bowel. this surgery was done about 2 onths ago. ever since then at regular intervals <3> she calls in complaining of bleeding when she wipes herself after voiding and complains that this is all from the vaginal area. she swears by it. yet when she comes in very care full detailed exams of the vaginal area show nothing..no blood at all. she is a little different in her manners and affect anyway and I get tempted to blow her off since she has totally negative exams three times now when she swears there is significant blood. yet it is so cycle precise..so rythmic. the bimanual and rectal exams are negative. and she is on ocps to suppress follicular cysts on the one remaing right ovary. <left out due to pain before.> before she had very limited endo at the time of the patvh-lso. there was no endo when I looked by scope and by hands on expierence 2 months ago. she gives very graphic detailed descriptions of her sex life and spills her guts about her husbands infidelities..and about how much she climaxes with sex <and incorporates it into her history of bleeding after coitus.> she describes a pain as being associated with the cycle time on her ocps--it's the same time frame she bleeds. question.....IS THERE A RADIOISOTPE OR SIMILAR STUDY THAT WOULD ALLOW US TO ISOLATE AND LABEL NEARLY MICROSCOPIC ENDO???...my only other choice is to do a cysto..pelviscopy and see how it goes. ct/mri likely won't help. any ideas as to etiology or work up appreciated. <psyche eval likely will be advised>
-- Mark Decker thanks a lot. mark decker md major surgery is done on me obgyn minor surgery I do one someone else. west bend wi I need to remember that. <perspective>.
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