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Selective arterial embolizationFrom: dahmd@gate.netTue Apr 30 14:03:05 1996
I just wanted to share with the list my first experience with Gelfoam hypogastric embolization, which is just about the neatest thing I have seen in a long time. 40 year old walk-in patient arrives at 0200 at 38 weeks, prior low transverse c/section for arrest of dilatation, active labor, no rupture of membranes, with transverse lie and funic (cord) presentation and 8cm right anterolateral fibroid along the lower uterine segment. Tried version under epidural just before the repeat c/section (kid would not budge, even with vibroacoustic stimulation!), then proceeded to c/section. Lots of scar tissue around paracolic gutters, bladder flap, and fascia. Went classical to avoid fibroid (patient wanted tubal ligation, anyway). Vigorous bleeding, could not close incision due to fibroid, and had to do a myomectomy. 1500cc later, after uterine artery ligation, bleeding stopped, incision closed, and hemostasis achieved (I watched everything for about 10 minutes while doing tubal). Put JP drain in "just in case" (a hunch?), and closed abdomen. 40 minutes later, JP starts slowly putting out blood, 30,60,150 cc/hour, despite normal vitals, coagulation profile, and abdominal exam. After watchful waiting (and praying) for a few hours, I gave patient a unit of blood, and took to radiology for embolization with Gelfoam. (Massive adhesions made patient a poor candidate for hypogastric artery ligation or hysterectomy). Despite not seeing a bleeding vessel, hypogastrics were embolized distal to posterior division, and bleeding stopped almost immediately. No complications. What a great trick. The patient is thrilled not to have had a hysterectomy, and wants to name her baby girl after me. But, as you all know, Ashley is a boy's name! Have a nice day, Ashley Hill D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL
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