Post Op Complications -- now what

[qhilldogs]

I had a LAVH 1/21/09 also ended up taking Left ovary because "it was attached to the uterus" and ended up bleeding in recovery. Exp. Lap to stop the bleeding. Transfused 8 units as well as FFP and Albumin. Post op ileus 9 day hospital stay. Ok here is the current question. 2 weeks post op I was back in the MD's office c/o RLQ/pelvic pain CT w/contrast done 2/1009 showed Complex pelvic collection Cranial/Caudal distance of 6cm and about 3.5cm in transverse diameter. it is about 3.8cm in AP diameter." after consult with my GYN and no acute s/s of infection decision was to wait and watch. during the waiting time I have continued with some mild to moderate discomfort that waxes and wains, it can wake me up at night at times and can be positional. Fast forward 3/10/09 Transvag. u/s for follow up showed "Complex cystic changes about the presumed right ovary 3.1 x 3.6 x 4.4 cm and multiple septated and internally echogenic cysts are present about this structure in the right pelvis"  Gyn did Internal exam after this and stated he could "feel the area". after long talk with GYN decision to wait and watch again, second opinion obtained from regional medical center with same outcome "watch and wait reimage in 2 weeks if symptoms not improved. CBC done WNL, continued with same discomfort. Fast forward toady 4/7/09 Follow up CT with contrast "slight enlargement in the septated collection in the right side of the pelvic cavity and I do not see evidence of acute inflammatory change around this abnormality and this my represent residue from a recent surgical collection. It is slightly larger in transverse diameter. it is still 6cm in Crainal/Caudal length."
ok so that is the history here is the question. Is it time for another trip to the OR? this continues to be a source of discomfort motrin and vicodin to control.

[Annekathryn Goodman, M.D.]

Hi There,
I  completely agree with how your gyn has managed this problem so far.
You had a postop operative bleed, it was manged, and you probably had a hematoma.

However, I suspect that currently , this is not a hematoma.  You have developed a cystic ovary as a consequence to the hysterectomy.
It is not rare (unrelated to the bleeding episode) to develop cystic change in a remaining ovary after hysterectomy.  It may be due to the reduction in blood supply to that ovary.

The ovary normal has two source of blood supply: from the main ovarian vessels which come down from the area of the kidneys and from the uterus.

So the uterine connection is disrupted normally when the uterus is removed. In some women this can lead to increased benign, painful ovarian cysts. I see this frequently in radical hysterectomy for cervical cancer .

At this point, I think I would bite the bullet and suggest the removal of your other ovary.

best wishes to you.

[qhilldogs]

Thank you so much for a response. I guesss I just wanted to hear it from another professional.

Thanks,

Michelle
Michelle W*** RN, BSN