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Re: F/U on TOAs with IUD in placeFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Tue May 26 22:04:08 1998
At Tue, 26 May 1998, Caryn Rybs wrote: > >Thanks for all of the responses to my post... > Use the force, Luke. . . Caryn: It sounds as though you are developing good Ob/Gyn "horse sense" through cases such as this. Your gut, as well as my gut, and several other good doctors on the list, points us towards definitive surgery. We all have thought of HIV and Actinomyces, too. Her lack of "looking sick" may reflect poor nutrition/immune status, or she really could have HIV (as did my last bad ER hit with TOAs, no IUD). Her IUD is the complicating factor in my mind that, since present and since she's still febrile, makes me opt for a TAH BSO. Hints: The tissue is friable, and easily bleeds. Use gentle blunt dissection--the adhesions are fresh, and will usually separate easily. Bowel Prep her. Drain her--Jackson Pratt or through the vagina. Midline incision, use Continuous Prolene or Double Strand PDS to close. You might want to do a Smead Jones with large PDS. You need a faculty member on this case, if that is not your normal custom (it was for us), as experience will be helpful in your learning. Let us know. Garry
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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