Main menu:

Google


Vaginal Bleed*1

History:

A 62-year-old female with diabetes comes to the ED for post-menopausal vaginal bleeding, about 2 pads/day, and lower abdominal “pressure”.  She denies vomiting, fever, diarrhea or other symptoms.  She recently had a UTI and is still on Bactrim but takes no blood thinners.

Exam:

Pulse 108, BP 130/62, Temp 98.4.  Large pannus that appears a bit pink.  Possibly swollen mons pubis but difficult to tell due to body habitus. Right labia major ulcer oozing blood.

Initial Concerns: malignancy, infection

Testing:

  • WBC = 22 with 9% bands
  • Glucose 305, bicarb 26, albumin 2.3
  • Pelvic ultrasound was normal for a post-menopausal woman
  • See CT scan below

uterus-ct

Questions:

  1. What does the CT show?
  2. What can cause this?

 

************************************************************

<<<<<<<<<<<<<<<<<<<< SPACER >>>>>>>>>>>>>>>>>>>>

QE4 cover

Get  Quick Essentials: Emergency Medicine or the Tarascon Emergency Department Quick Reference Guide

<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>

***********************************************************

ANSWERS:

  1. The CT shows an atrophic uterus with gas (black) tracking along the abdominal wall extending over the rectus sheath and into the labia majora, worse on the right (see arrows in images below)
  2. This is consistent with Fournier’s Gangrene.

necrotizing-fasciitis

fourniers-gangrene

****

FOURNIER’S GANGRENE from QUICK ESSENTIALS: Emergency Medicine 1-minute consult pocketbook

 

****

Case Conclusion: Patient was given Zosyn and Clindamycin and taken to the OR.  She survived.

:
Google
 
Web www.edinsight.com