tailieunhanh - Phương pháp điều trị sản khoa - Tình huống số 3

Tham khảo tài liệu 'phương pháp điều trị sản khoa - tình huống số 3', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 12 A 45-year-old woman underwent a total abdominal hysterectomy for symptomatic endometriosis 2 days previously. She complains of right Hank tenderness. On examination her temperature is 102 F HR is 100 min and BP is 130 90. Her heart and lung examinations are normal. The abdomen is slightly tender diffusely with normal bowel sounds. The incision appears within normal limits. Exquisite right costovertebral angle tenderness is noted. What would be your next diagnostic step What is the most likely diagnosis ỉ 12 CASE 1 ILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 12 Ureteral Injury after Hysterectomy Siinimarv A 45-year-old woman who underwent a total abdominal hysterectomy lor symptomatic endometriosis two days previously has right flank tenderness lever of IO2 F and exquisite costovertebral angle tenderness. The incision appears normal. Next step Intravenous pyelogram IVP . Most likely diagnosis Right ureteral obstruction or injury. Analysis Objectives 1. Understand that the urinary tract is sometimes injured in pelvic surgery. 2. Know the common presentations of ureteral and bladder injuries after gynecologic surgery. 3. Know some of the conditions that predispose patients to urinary tract injury. Considerations This patient has a clinical picture identical to pyelonephritis however because she has recently undergone a hysterectomy injury to or obstruction of the ureter is of paramount concern. Endometriosis tends to obliterate tissue planes making ureteral injury more likely. The intravenous pyelogram IVP is the best initial test to evaluate this disorder. If the same clinical picture were present without the recent surgery then the most likely diagnosis would be pyelonephritis and the next step would be intravenous antibiotics and urine culture. Finally the wound is normal which argues against a wound infection causing the postoperative fever. CLINICAL CASI-S 113 APPROACH TO URETERAL INJURIES Definitions Cardinal ligament The attachments of the uterine .