Examkin

Soru

Zorluk: KolayGynecologic Procedures and Complications

A physician is called to the bedside to evaluate a 41-year-old female patient on her first postoperative night following a vaginal hysterectomy for uterine prolapse. She complains of new-onset, severe lower abdominal cramping and an intense feeling of rectal pressure. She also reports feeling dizzy when sitting up. Vital signs show a temperature of 37.4°C (99.3°F), blood pressure of 96/58 mm Hg, and a heart rate of 115/min. Her abdomen is soft with mild suprapubic tenderness. Pelvic examination reveals intact vaginal sutures, but there is a 6-cm, tense, purple-tinged, boggy mass protruding into the vaginal vault. Laboratory evaluation reveals a hemoglobin concentration of 7.8 g/dL (baseline was 13.1 g/dL preoperatively). Which of the following is the most likely diagnosis?

  1. Pelvic hematomaCevap
  2. B
    Vaginal cuff evisceration
  3. C
    Delayed bowel perforation
  4. D
    Pelvic abscess
  5. E
    Vesicovaginal fistula

Cevap

The most likely diagnosis is a pelvic hematoma, evidenced by hemorrhagic shock and a boggy mass at the vaginal apex.
The patient's presentation is highly characteristic of a postoperative pelvic hematoma. She is experiencing systemic signs of acute, severe blood loss, including resting tachycardia, hypotension, orthostatic dizziness, and a precipitous drop in hemoglobin. The pelvic examination confirms the diagnosis by revealing a tense, purple, boggy mass at the vaginal apex. This represents an accumulation of blood in the retroperitoneal space above the vaginal cuff, which expands and compresses the adjacent rectum, leading to the patient's intense rectal pressure.

Adım Adım Çözüm

1
Analyze the patient's vital signs and laboratory findings.
The patient exhibits tachycardia (115/min), hypotension (96/58 mm Hg), dizziness on sitting, and a massive drop in hemoglobin (13.1 to 7.8 g/dL).
Establishing the presence of acute hemorrhagic shock narrows the differential diagnosis to bleeding complications.
2
Correlate systemic findings with the localized physical exam findings and symptoms.
The patient reports intense rectal pressure, and examination reveals a 6-cm, tense, purple-tinged, boggy mass protruding into the vaginal vault.
This localizes the bleeding to the surgical bed above the vaginal cuff. The hematoma compresses the adjacent rectum, explaining the rectal pressure symptom.
3
Synthesize the timeline, systemic signs, and physical findings to confirm the diagnosis.
An acute presentation on postoperative day 1 featuring hemorrhagic shock and a local blood collection confirms a postoperative pelvic hematoma.
It definitively rules out infectious causes (abscess), structural non-vascular damage (fistula, evisceration), and visceral damage (bowel perforation).

Anahtar Kavram

Postoperative pelvic hematoma after hysterectomy classically presents with signs of acute blood loss (tachycardia, hypotension, dropping hemoglobin) and a localized pelvic mass causing pressure symptoms (e.g., rectal pressure).
Tahmini Süre:1m 0s
Bu soruyu puanla

Konular

Gynecologic Procedures and Complications

Bu konudan daha fazla soru