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Re: GYN: Pelvic Mass (long--good case)From: Garry E. Siegel, M.D. (garrys@mindspring.com)Sun Mar 29 20:33:37 1998
At Sun, 29 Mar 1998, Calvin J. Siegers, MD FACOG wrote: > >At Sat, 28 Mar 1998, Garry E. Siegel, M.D. wrote: >> >Garry, >What did ID say RE etiology, offending microorganisms, choice of >antibiotics before and after surgery? If radiology didn't think the CT >looked like TOA, what did they think? How many plts did heme/onc give >and do you think it made a difference? If the other ovary wasn't >involved why was it stuck down? Leaving the corpus and the other ovary >was a calculated, I'm sure, risk, and I hope your VERY sick lady does >well now. She's still at some risk for combat shock, third-space fluid >shifts, big ileus, > >renal failure, ARDS, but I think you've won the sepsis war. Cal > >-- >Calvin J. Siegers, MD FACOG...private practice, 20 yr veteran, Holland, MI > You are a wise and experience gynecologist, and may well be right. The ID man didn't speculate on the organisms (multi-organism, we all know), and the antibiotics were levoquin, flagyl, and aztreonam, I believe. We gave 2 16 unit platelet transfusions, one preop and one intraop. I don't believe that they made any difference but they treated the doctors, especially the anesthesiologist. The radiologist waxed as to whether these were TOAs, as there was an astounding lack of inflammatory response on the CT. My feeling is that her diabetes allowed her to mask things, and that is why she is so sick. As of Sunday morning, she got sicker, and needed to be intubated. I am debating as to whether this is aftermath in a sick diabetic, versus remaining infected/necrotic tissue. My partner, with whom I operated, really felt strongly about leaving the ovary, as my gut was to remove it. I agreed with him in leaving the corpus, as she was sick and we needed to get her out of the OR. If she doesn't get better soon, we'll go back in. And if I go back in, I plan a hyst (maybe supracervical) and removal of the remaining ovary. Garry
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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