|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: adhesionsFrom: mark decker (mdecker@nconnect.net)Sun Nov 17 11:09:53 1996
At 10:17 AM 9/28/96 -0500, you wrote: >Major adhesions at ime of C/S do seem to be a very rare but difficult problem. >Recently one of our senior consultants ended up going through both the anterior >and posterior bladder walls to deliver a young prim breech at term. I did a primary section several years ago for ftp. the patient developed a post op fever and required antibiotic therapy for 10 days or so. also went back in a year or two later secondary to lots of pelvic pain with ovulation on the right side. we found lots of scarring. freed up the right adnexal scarring and most of the scarring on the left side but without a full bowel prep I had to leave the colonic attachments to the posterior uterus so as to avoid a possible colostomy if I worked on these thick adhesions. after the patient decided to give up on in vitro and with several more frequent and severe bouts of partial bowel obstruction she elected for a hysterectomy. right and left..esp left adnexal discomfort and narrowing of stool caliber, nausea, emesis and pain cyclical with menses. the general surgeon and I took her to the OR with a full prep and ureteral stents. as per my last op note it took 41/4 hours to deal with the ubiquitous adhesions and get the tahbso done. the general surgeon took 1 1/4 haour just to get to the uterus. two hours for bowel adhesions and two hours for the tahbso..the latter due to the colon being densely and broadly attached to the ant. abd. wall..to the top and entire back of the uterus and to the bladder. the adnexae were approached retroperitoneally as a safety issue and due to the left ovary and right ovary being buried under lots of thick adhesions. an emergent c-section on this patient would have led to multiple large bowel injuries.. this was one of the two toughest hyst's I have done and I suspect I have done about 400 or so since residency. some people have all the bad luck. mark -- mark decker md major surgery is done on me obgyn - avid biker minor surgery I do one someone else. midwest usa I need to remember that. <perspective>.
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 05:19:56 2009 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.