Book contents
- Surgical Gynecology
- Surgical Gynecology
- Copyright page
- Contents
- Contributors
- Preface
- Case 1 A 45-Year-Old Woman Undergoing Hysterectomy Requests Oophorectomy
- Case 2 A 40-Year-Old G0 Developmentally Delayed Woman Requires Hysterectomy
- Case 3 A 45-Year-Old Woman with Possible Penicillin Allergy Scheduled for Hysterectomy
- Case 4 A 50-Year-Old Woman with Prior DVT Undergoing Hysterectomy
- Case 5 A 40-Year-Old Woman with Severe Anemia Scheduled for Surgery Refuses Blood Products
- Case 6 A 55-Year-Old Woman Inquires about Your Institution’s Protocols for Enhanced Recovery after Surgery
- Case 7 A 55-Year-Old Female with a 25-Year Smoking History and COPD Is Undergoing a Robotic Hysterectomy
- Case 8 A 48-Year-Old with Adult-Onset Diabetes Is Undergoing a Hysterectomy for Recurrent Simple Hyperplasia
- Case 9 A 10-Year-Old Girl with a Vulvar Hematoma after Playground Injury
- Case 10 A 50-Year-Old Woman with a Discrete Area of Leukoplakia That on In-Office Punch Biopsy Showed VIN 3
- Case 11 A 50-Year-Old Woman with a Recurrent Bartholin’s Gland Cyst
- Case 12 A 21-Year-Old Woman with Labial Pain During Exercise
- Case 13 A 33-Year-Old Woman with Localized Vulvodynia without Vaginismus
- Case 14 A 24-Year-Old Woman with Multiple Large Vulvar Condyloma
- Case 15 A 70-Year-Old with Vulvar Paget’s Disease
- Case 16 A 45-Year-Old Female with Multifocal VIN
- Case 17 A 70-Year-Old Woman with Diabetes, Exquisitely Painful 2 cm Vulvar Ulcerative Lesion, and Subcutaneous Gas on CT Scan
- Case 18 A 14-Year-Old Adolescent with Cyclic Pelvic Pain and Amenorrhea
- Case 19 A 40-Year-Old Woman with a 3 cm Mass Prolapsing through the Cervix
- Case 20 A 35-Year-Old Woman with a Fetal Demise at 20 Weeks’ Gestation
- Case 21 A 25-Year-Old Woman with Intrauterine Embryonic Demise and Temperature of 39.2°C
- Case 22 A 40-Year-Old G0 Woman with Endometrial Intraepithelial Neoplasia Desiring Hysterectomy
- Case 23 A 35-Year-Old G3P3 Woman with a 12-Week Uterus and a Prior Cesarean Section Who Desires Vaginal Hysterectomy
- Case 24 A 42-Year-Old G2P2 Woman Undergoing Vaginal Hysterectomy with Difficulty Entering the Peritoneum
- Case 25 A 28-Year-Old P0 Woman with Adenocarcinoma In Situ Has Intraoperative Bleeding during a Cold-Knife Conization
- Case 26 A 30-Year-Old G1 Woman with Suspected Uterine Perforation during Suction Dilation and Curettage
- Case 27 A 39-Year-Old P4 Woman with Recurrent HSIL after LEEP
- Case 28 A 34-Year-Old G2P1 Woman with Elevated β-hCG (>250 000 mIU/mL) and Concern for Molar Gestation
- Case 29 A 35-Year-Old G3P2 Woman with Persistent Bleeding after Suction D&C
- Case 30 A 70-Year-Old G0 Woman with Postmenopausal Bleeding and Severe Vaginal Atrophy
- Case 31 A 28-Year-Old G3P2 Woman Presents at Eight Weeks with a Cervical Ectopic Pregnancy
- Case 32 A 45-Year-Old Woman with Leg Weakness following a Vaginal Hysterectomy
- Case 33 A 45-Year-Old Woman Undergoes a Transvaginal Midurethral Sling and Is Unable to Void after the Procedure
- Case 34 A 65-Year-Old Woman Presents with a Symptomatic Stage 2 Rectocele
- Case 35 A 55-Year-Old Woman with Stress Urinary Incontinence without Uterine Prolapse
- Case 36 A 45-Year-Old P2 Woman Undergoing Vaginal Hysterectomy Who Desires Opportunistic Salpingectomy
- Case 37 A 32-Year-Old G2P2 with Bleeding from a 5 cm Vaginal Laceration after Sexual Assault
- Case 38 A 50-Year-Old Woman Loses Consciousness during an Office Hysteroscopy
- Case 39 A 44-Year-Old Woman with Intermenstrual Spotting
- Case 40 A 71-Year-Old G2P2 Woman with Postmenopausal Bleeding and Severe Cervical Stenosis
- Case 41 A 34-Year-Old G2P2 Woman with a 4 cm Type 1 Submucosal Myoma Undergoing a Hysteroscopic Myomectomy
- Case 42 A 50-Year-Old Woman with a Retained IUD
- Case 43 A 30-Year-Old Woman Seeking Pregnancy Who Has Intrauterine Synechiae
- Case 44 A 42-Year-Old Woman with Abnormal Uterine Bleeding Who Desires In-Office Ablation
- Case 45 A 55-Year-Old G1P1 Woman with New-Onset Vaginal Bleeding after Prior Endometrial Ablation
- Case 46 A 22-Year-Old G3P0030 Woman with Recurrent Pregnancy Loss and Uterine Septum
- Case 47 A 33-Year-Old G2P2 Woman with Persistent Irregular Vaginal Bleeding after Cesarean Delivery
- Case 48 A 38-Year-Old G3P2 Woman with Pelvic Pain following Endometrial Ablation
- Case 49 A 33-Year-Old Woman with Acute Hypoxia during Hysteroscopic Myomectomy
- Case 50 A 40-Year-Old Woman Desires Endometrial Ablation for Heavy Menstrual Bleeding
- Case 51 A 24-Year-Old G0 Woman with Suspected Endometriosis Who Has Failed Medical Management
- Case 52 A 35-Year-Old G0 Woman with Chronic Pain and Multiple Prior Surgeries Undergoing Diagnostic Laparoscopy
- Case 53 A 25-Year-Old Woman with Sudden Cardiovascular Collapse after Creation of Pneumoperitoneum
- Case 54 A 30-Year-Old G0 Woman with 6 cm Complex Ovarian Cyst Suspicious for Borderline Ovarian Tumor
- Case 55 A 32-Year-Old G4P4 Woman with Through-and-Through Small Bowel Penetration on Placement of Umbilical Port
- Case 56 A 43-Year-Old G3P3 BRCA1 Carrier Desiring Risk-Reducing Salpingo-oophorectomy
- Case 57 A 34-Year-Old G3P3 Is Undergoing an Interval Bilateral Salpingectomy. During Initial Trocar Insertion, Bright Red Blood Is Noted to Be Filling the Pelvis
- Case 58 A 28-Year-Old G0 Woman with Stage IV Endometriosis and an Obliterated Posterior Cul-de-sac
- Case 59 A 40-Year-Old G3P3 Woman with 20 cm Unilateral Simple Cyst
- Case 60 A 16-Year-Old Female G0 Adolescent with Acute Pelvic Pain
- Case 61 A 29-Year-Old G2P0 Woman with Symptomatic Ectopic Pregnancy and History of Prior Salpingectomy
- Case 62 A 35-Year-Old P2 Woman with Preperitoneal Insufflation at Time of Laparoscopy
- Case 63 A 38-Year-Old Woman Who Desires Device Removal after Hysteroscopic Sterilization
- Case 64 A 28-Year-Old Woman with a 6 cm Complex Mass Adherent to the Pelvic Sidewall
- Case 65 A 21-Year-Old Woman with an 8 cm Adnexal Mass Presumed to Be a Dermoid Tumor
- Case 66 A 24-Year-Old G2P1 Woman with an Eight-Week Interstitial Ectopic Pregnancy
- Case 67 A 16-Year-Old G0 Adolescent with Acute Psychosis and 3 cm Ovarian Dermoid Cyst
- Case 68 A 23-Year-Old Woman with Cyclic Pelvic Pain and Suspected Obstructed Rudimentary Uterine Horn
- Case 69 A 31-Year-Old Woman with Cesarean Scar Pregnancy
- Case 70 A 35-Year-Old Woman with Bleeding from a Right Lower Abdominal Trocar Site
- Case 71 A 21-Year-Old Woman with an Intra-abdominal IUD
- Case 72 A 32-Year-Old G2P1 Woman with Ovarian Pregnancy Noted at Time of Surgery for Presumed Tubal Ectopic
- Case 73 A 32-Year-Old P0 Woman with Persistent Pain after LAVH/BSO for Endometriosis
- Case 74 A 50-Year-Old Woman with Bleeding with Intercourse Four Weeks after Robotic Hysterectomy
- Case 75 A 42-Year-Old Woman Who Desires Minimally Invasive Surgery for a 20-Week-Sized Uterus
- Case 76 A 40-Year-Old Woman with No Spill from Her Left Ureter on Postoperative Cystoscopy after Total Laparoscopic Hysterectomy with Bilateral Salpingectomy
- Case 77 A 40-Year-Old G1P1 Woman with Endometriosis Desiring Definitive Management
- Case 78 A 40-Year-Old G4P4 Woman with 16-Week-Size Fibroid Uterus and Abnormal Uterine Bleeding Desiring Hysterectomy
- Case 79 A 45-Year-Old Woman with Vaginal Bleeding and Fever to 38.3°C after Hysterectomy
- Case 80 A 45-Year-Old Woman with Decreased Urine Output on POD#1 after Robotic-Assisted Total Laparoscopic Hysterectomy
- Case 81 A 38-Year-Old G0 Woman with a 4 Cm Umbilical Mass
- Case 82 A 26-Year-Old G0 Woman with Large Multifibroid Uterus Desiring Myomectomy
- Case 83 A 45-Year-Old Woman with a Foul-Smelling Pfannenstiel Incision on POD 7
- Case 84 A 45-Year-Old Woman with Watery Vaginal Discharge Six Weeks after Hysterectomy
- Case 85 A 34-Year-Old G0 Jehovah’s Witness Undergoing Myomectomy
- Case 86 A 50-Year-Old G0 Woman with Class III Obesity Undergoing Abdominal Hysterectomy
- Case 87 A 60-Year-Old G2P2 Woman with Nausea and Abdominal Distension Following Abdominal Hysterectomy and Lysis of Bowel Adhesions
- Case 88 A 15-Year-Old Adolescent with Severe Abdominal Pain and Hemoperitoneum
- Case 89 A 24-Year-Old Woman Presents with Evidence of a Ruptured Ectopic Pregnancy and Is Reporting Concomitant Fever, Chills, and a Productive Cough
- Case 90 A 26-Year-Old Female Presents for Nexplanon Removal with a Non-palpable Device
- Index
- References
Case 79 - A 45-Year-Old Woman with Vaginal Bleeding and Fever to 38.3°C after Hysterectomy
Published online by Cambridge University Press: 19 November 2021
Book contents
- Surgical Gynecology
- Surgical Gynecology
- Copyright page
- Contents
- Contributors
- Preface
- Case 1 A 45-Year-Old Woman Undergoing Hysterectomy Requests Oophorectomy
- Case 2 A 40-Year-Old G0 Developmentally Delayed Woman Requires Hysterectomy
- Case 3 A 45-Year-Old Woman with Possible Penicillin Allergy Scheduled for Hysterectomy
- Case 4 A 50-Year-Old Woman with Prior DVT Undergoing Hysterectomy
- Case 5 A 40-Year-Old Woman with Severe Anemia Scheduled for Surgery Refuses Blood Products
- Case 6 A 55-Year-Old Woman Inquires about Your Institution’s Protocols for Enhanced Recovery after Surgery
- Case 7 A 55-Year-Old Female with a 25-Year Smoking History and COPD Is Undergoing a Robotic Hysterectomy
- Case 8 A 48-Year-Old with Adult-Onset Diabetes Is Undergoing a Hysterectomy for Recurrent Simple Hyperplasia
- Case 9 A 10-Year-Old Girl with a Vulvar Hematoma after Playground Injury
- Case 10 A 50-Year-Old Woman with a Discrete Area of Leukoplakia That on In-Office Punch Biopsy Showed VIN 3
- Case 11 A 50-Year-Old Woman with a Recurrent Bartholin’s Gland Cyst
- Case 12 A 21-Year-Old Woman with Labial Pain During Exercise
- Case 13 A 33-Year-Old Woman with Localized Vulvodynia without Vaginismus
- Case 14 A 24-Year-Old Woman with Multiple Large Vulvar Condyloma
- Case 15 A 70-Year-Old with Vulvar Paget’s Disease
- Case 16 A 45-Year-Old Female with Multifocal VIN
- Case 17 A 70-Year-Old Woman with Diabetes, Exquisitely Painful 2 cm Vulvar Ulcerative Lesion, and Subcutaneous Gas on CT Scan
- Case 18 A 14-Year-Old Adolescent with Cyclic Pelvic Pain and Amenorrhea
- Case 19 A 40-Year-Old Woman with a 3 cm Mass Prolapsing through the Cervix
- Case 20 A 35-Year-Old Woman with a Fetal Demise at 20 Weeks’ Gestation
- Case 21 A 25-Year-Old Woman with Intrauterine Embryonic Demise and Temperature of 39.2°C
- Case 22 A 40-Year-Old G0 Woman with Endometrial Intraepithelial Neoplasia Desiring Hysterectomy
- Case 23 A 35-Year-Old G3P3 Woman with a 12-Week Uterus and a Prior Cesarean Section Who Desires Vaginal Hysterectomy
- Case 24 A 42-Year-Old G2P2 Woman Undergoing Vaginal Hysterectomy with Difficulty Entering the Peritoneum
- Case 25 A 28-Year-Old P0 Woman with Adenocarcinoma In Situ Has Intraoperative Bleeding during a Cold-Knife Conization
- Case 26 A 30-Year-Old G1 Woman with Suspected Uterine Perforation during Suction Dilation and Curettage
- Case 27 A 39-Year-Old P4 Woman with Recurrent HSIL after LEEP
- Case 28 A 34-Year-Old G2P1 Woman with Elevated β-hCG (>250 000 mIU/mL) and Concern for Molar Gestation
- Case 29 A 35-Year-Old G3P2 Woman with Persistent Bleeding after Suction D&C
- Case 30 A 70-Year-Old G0 Woman with Postmenopausal Bleeding and Severe Vaginal Atrophy
- Case 31 A 28-Year-Old G3P2 Woman Presents at Eight Weeks with a Cervical Ectopic Pregnancy
- Case 32 A 45-Year-Old Woman with Leg Weakness following a Vaginal Hysterectomy
- Case 33 A 45-Year-Old Woman Undergoes a Transvaginal Midurethral Sling and Is Unable to Void after the Procedure
- Case 34 A 65-Year-Old Woman Presents with a Symptomatic Stage 2 Rectocele
- Case 35 A 55-Year-Old Woman with Stress Urinary Incontinence without Uterine Prolapse
- Case 36 A 45-Year-Old P2 Woman Undergoing Vaginal Hysterectomy Who Desires Opportunistic Salpingectomy
- Case 37 A 32-Year-Old G2P2 with Bleeding from a 5 cm Vaginal Laceration after Sexual Assault
- Case 38 A 50-Year-Old Woman Loses Consciousness during an Office Hysteroscopy
- Case 39 A 44-Year-Old Woman with Intermenstrual Spotting
- Case 40 A 71-Year-Old G2P2 Woman with Postmenopausal Bleeding and Severe Cervical Stenosis
- Case 41 A 34-Year-Old G2P2 Woman with a 4 cm Type 1 Submucosal Myoma Undergoing a Hysteroscopic Myomectomy
- Case 42 A 50-Year-Old Woman with a Retained IUD
- Case 43 A 30-Year-Old Woman Seeking Pregnancy Who Has Intrauterine Synechiae
- Case 44 A 42-Year-Old Woman with Abnormal Uterine Bleeding Who Desires In-Office Ablation
- Case 45 A 55-Year-Old G1P1 Woman with New-Onset Vaginal Bleeding after Prior Endometrial Ablation
- Case 46 A 22-Year-Old G3P0030 Woman with Recurrent Pregnancy Loss and Uterine Septum
- Case 47 A 33-Year-Old G2P2 Woman with Persistent Irregular Vaginal Bleeding after Cesarean Delivery
- Case 48 A 38-Year-Old G3P2 Woman with Pelvic Pain following Endometrial Ablation
- Case 49 A 33-Year-Old Woman with Acute Hypoxia during Hysteroscopic Myomectomy
- Case 50 A 40-Year-Old Woman Desires Endometrial Ablation for Heavy Menstrual Bleeding
- Case 51 A 24-Year-Old G0 Woman with Suspected Endometriosis Who Has Failed Medical Management
- Case 52 A 35-Year-Old G0 Woman with Chronic Pain and Multiple Prior Surgeries Undergoing Diagnostic Laparoscopy
- Case 53 A 25-Year-Old Woman with Sudden Cardiovascular Collapse after Creation of Pneumoperitoneum
- Case 54 A 30-Year-Old G0 Woman with 6 cm Complex Ovarian Cyst Suspicious for Borderline Ovarian Tumor
- Case 55 A 32-Year-Old G4P4 Woman with Through-and-Through Small Bowel Penetration on Placement of Umbilical Port
- Case 56 A 43-Year-Old G3P3 BRCA1 Carrier Desiring Risk-Reducing Salpingo-oophorectomy
- Case 57 A 34-Year-Old G3P3 Is Undergoing an Interval Bilateral Salpingectomy. During Initial Trocar Insertion, Bright Red Blood Is Noted to Be Filling the Pelvis
- Case 58 A 28-Year-Old G0 Woman with Stage IV Endometriosis and an Obliterated Posterior Cul-de-sac
- Case 59 A 40-Year-Old G3P3 Woman with 20 cm Unilateral Simple Cyst
- Case 60 A 16-Year-Old Female G0 Adolescent with Acute Pelvic Pain
- Case 61 A 29-Year-Old G2P0 Woman with Symptomatic Ectopic Pregnancy and History of Prior Salpingectomy
- Case 62 A 35-Year-Old P2 Woman with Preperitoneal Insufflation at Time of Laparoscopy
- Case 63 A 38-Year-Old Woman Who Desires Device Removal after Hysteroscopic Sterilization
- Case 64 A 28-Year-Old Woman with a 6 cm Complex Mass Adherent to the Pelvic Sidewall
- Case 65 A 21-Year-Old Woman with an 8 cm Adnexal Mass Presumed to Be a Dermoid Tumor
- Case 66 A 24-Year-Old G2P1 Woman with an Eight-Week Interstitial Ectopic Pregnancy
- Case 67 A 16-Year-Old G0 Adolescent with Acute Psychosis and 3 cm Ovarian Dermoid Cyst
- Case 68 A 23-Year-Old Woman with Cyclic Pelvic Pain and Suspected Obstructed Rudimentary Uterine Horn
- Case 69 A 31-Year-Old Woman with Cesarean Scar Pregnancy
- Case 70 A 35-Year-Old Woman with Bleeding from a Right Lower Abdominal Trocar Site
- Case 71 A 21-Year-Old Woman with an Intra-abdominal IUD
- Case 72 A 32-Year-Old G2P1 Woman with Ovarian Pregnancy Noted at Time of Surgery for Presumed Tubal Ectopic
- Case 73 A 32-Year-Old P0 Woman with Persistent Pain after LAVH/BSO for Endometriosis
- Case 74 A 50-Year-Old Woman with Bleeding with Intercourse Four Weeks after Robotic Hysterectomy
- Case 75 A 42-Year-Old Woman Who Desires Minimally Invasive Surgery for a 20-Week-Sized Uterus
- Case 76 A 40-Year-Old Woman with No Spill from Her Left Ureter on Postoperative Cystoscopy after Total Laparoscopic Hysterectomy with Bilateral Salpingectomy
- Case 77 A 40-Year-Old G1P1 Woman with Endometriosis Desiring Definitive Management
- Case 78 A 40-Year-Old G4P4 Woman with 16-Week-Size Fibroid Uterus and Abnormal Uterine Bleeding Desiring Hysterectomy
- Case 79 A 45-Year-Old Woman with Vaginal Bleeding and Fever to 38.3°C after Hysterectomy
- Case 80 A 45-Year-Old Woman with Decreased Urine Output on POD#1 after Robotic-Assisted Total Laparoscopic Hysterectomy
- Case 81 A 38-Year-Old G0 Woman with a 4 Cm Umbilical Mass
- Case 82 A 26-Year-Old G0 Woman with Large Multifibroid Uterus Desiring Myomectomy
- Case 83 A 45-Year-Old Woman with a Foul-Smelling Pfannenstiel Incision on POD 7
- Case 84 A 45-Year-Old Woman with Watery Vaginal Discharge Six Weeks after Hysterectomy
- Case 85 A 34-Year-Old G0 Jehovah’s Witness Undergoing Myomectomy
- Case 86 A 50-Year-Old G0 Woman with Class III Obesity Undergoing Abdominal Hysterectomy
- Case 87 A 60-Year-Old G2P2 Woman with Nausea and Abdominal Distension Following Abdominal Hysterectomy and Lysis of Bowel Adhesions
- Case 88 A 15-Year-Old Adolescent with Severe Abdominal Pain and Hemoperitoneum
- Case 89 A 24-Year-Old Woman Presents with Evidence of a Ruptured Ectopic Pregnancy and Is Reporting Concomitant Fever, Chills, and a Productive Cough
- Case 90 A 26-Year-Old Female Presents for Nexplanon Removal with a Non-palpable Device
- Index
- References
Summary
A 45-year-old women presents to the emergency room complaining of vaginal bleeding and fevers at home to 38.3°C. She is six days post-op from a robotic hysterectomy, bilateral salpingectomy. The patient had normal return of bowel and bladder function and has been taking ibuprofen 600 mg every 6 hours alternating with oxycodone/acetaminophen 5/325 mg every 6 hours as needed for pain relief. She states that she really felt good for the first few days with only some light spotting since the procedure. Over the last 24 hours, she has noticed an increase in the discharge and stated it is now foul smelling. Her pain level and fatigue have increased over the last 12 hours, and she rates the pain in her abdomen as a 5 out of 10.
- Type
- Chapter
- Information
- Surgical GynecologyA Case-Based Approach, pp. 241 - 243Publisher: Cambridge University PressPrint publication year: 2021
References
Mahdi, H, Goodrich, D, Lockhart, D, et al. Predictors of surgical site infections in women undergoing hysterectomy for benign gynecologic disease; a multicenter analysis using the national surgical quality improvement data. J Minim Invasive Gynecol 2014; 21: 901–9.CrossRefGoogle Scholar
Centers for Disease Control and Prevention. Surgical site infection SSI0 event. Procedure-assisted module. Atlanta, GA: CDC; 2018.Google Scholar
Prevention of infection after gynecologic procedures: ACOG Practice Bulletin, Number 195. Obstet Gynecol 2018; 131: e172–89.Google Scholar
Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guidelines for prevention of surgical site infection. 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999; 20: 250–78.CrossRefGoogle ScholarPubMed
Lachiewc, M, Moulron, L, Jaiyeoba, O. Pelvic surgical site infections in gynecologic surgery. Infect Dis Obstet Gynecol 2015; 2015: 614590.Google Scholar
Committee Opinion No. 571: Solutions for the preparation of the vagina. Obstet Gynecol 2013; 122: 718–20.Google Scholar
Rosen, M Breitkkopf, D Waud, K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv 2009; 64(10): 681–9.CrossRefGoogle ScholarPubMed
To, J, Aldape, D, Frost, A, et al. Image guided drainage verses antibiotic only treatment of pelvic abscesses: short- and long-term outcomes. Fert Steril 2014; 102(4): 1155–9.CrossRefGoogle Scholar
Faro, C, Faro, S. Post-operative pelvic infections. Infect Dis Clinic North Am 2008; 22(4): 653–63.Google Scholar