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Re: My case list...From: Jane Helwig, MD (jane@seasonedsystems.com)Sat May 30 17:25:58 1998
At Sat, 30 May 1998, Dr Eberhard W Lisse wrote:
>Why did you do that? I can reluctantly agree to managing ectopics by laparoscopy if El, in retrospect I certainly wish I had done a laparotomy initially and gotten the thing out with zero blood loss. The cul-de-sac mass looked large on sono, but I have had others that looked large on ultrasound and turned out to be smaller than expected. Diagnostic L/S seemed a reasonable option. Had the ectopic been in the tube, could have done a salpingectomy laparoscopically.
>Approach it as "fetal distress" and you should She had 2 previous c/s via the midline incision and a previous open chole, and weighs 280lb. I wanted to minimize enterotomy risk. It may not have taken 5 whole minutes, but it seemed like 5 hours.
>Was this fresh blood? Yes, absolutely no blood there before it ruptured intraoperatively. This was an unusual ectopic. . .no bleeding, no abdominal pain (consistent with the ovarian implantation). In fact, the patient presented because of carpal tunnel syndrome and a very astute nurse-practitioner elicited a history of missed menses and previous BTL, then got pregnancy test which was positive and sent her to us.
>Yes indeed. Blood is one of the most dangerous products we are allowed Bravo. Thanks, El!
-- Jane Helwig, MD Private practice Nassawadox, VA
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