Clinical Pearls

Fascial disruption is a concern when copious amounts of serosan-guineous fluid are draining from an abdominal incision.

A surgical site infection with fascial disruption or evisceration should be repaired immediately.

The most common time period in which fascial disruption or evisceration occurs is 5 to 14 days postoperatively.

A superficial wound separation usually occurs due to infection or hematoma and is treated by opening the wound and using wet-to-dry dressing changes.

REFERENCES

Centers for Disease Control. Definitions of nosocomial infections. Appendix A-1.

Available at www.cdc.gov. Last accessed October 3, 2005. Droegemuller W. Preoperative counseling and management. In: Stenchever MA. Droegemueller W. Herbst AL. Mishell DR. eds. Comprehensive gynecology. 4th ed. St. Louis: Mosby-Year Book, 2001:771-825. Gallup DG. Incisions for gynecologic surgery. In: Rock JA. Thomson JD. eds. Telinde's operative gynecology. 8th ed. Philadelphia: Lippincott-Raven, 1997: 308-311.

Surgical incisions: prevention and treatment complications. Available at www. uptodate.com. Last accessed October 3, 2005.

A 25-year-old woman at 10 weeks' gestation complains of severe abdominal pain and feeling faint for the last hour. She had moderately heavy vaginal bleeding that began yesterday morning and noted that some tissue possibly passed vaginally. The tissue brought into the office floats in a "frond" pattern when placed in saline. Currently, she denies vaginal bleeding but feels lightheaded. On examination, her blood pressure is 90/60, heart rate 120 bpm, and temperature 99°F. Her abdomen is diffusely tender, distended, with rebound tenderness, and a fluid wave is present. The cervix is closed.

^ What is the most likely diagnosis?

^ What is your next step in the management?

ANSWERS TO CASE 41: Abdominal Pain in Pregnancy (Ruptured Corpus Luteum)

Summary: A 25-year-old woman at 10 weeks' gestation complains of severe abdominal pain and lightheadedness. Yesterday, she had moderately heavy vaginal bleeding and passed some tissue, which floats with a "frond" pattern. Her blood pressure is 90/60. heart rate 120 bpm, and temperature 99°F. Her abdomen is diffusely tender, distended, with rebound tenderness, and a fluid wave is present. The cervix is closed.

^ Most likely diagnosis: Ruptured corpus luteum cyst with hemoperitoneum.

^ Next step in the management: Admission to the hospital with surgical intervention (laparoscopy or laparotomy).

Analysis

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