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Interesting Case Rounds Rebecca Burton-MacLeod R4, Emerg Med June 28 th, 2007.

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Presentation on theme: "Interesting Case Rounds Rebecca Burton-MacLeod R4, Emerg Med June 28 th, 2007."— Presentation transcript:

1 Interesting Case Rounds Rebecca Burton-MacLeod R4, Emerg Med June 28 th, 2007

2 Case 11F transferred from PLC to ACH ED after sustaining a vulvar hematoma Pt was skateboarding and fell off, landing on her buttocks Immediate pain to perineum Pt stated that swelling noted to genitals within 5min; when parents arrived home 1hr later, marked swelling

3 History Any other questions you wish to ask?

4 Case contd On examination: –Hemodynamically stable –++ purplish-discolouration bulging mass to R labia; small laceration at 6 oclock position on R labia –L labia appears normal –Unable to examine vaginal opening or other midline structures due to swelling –Anus normal –No other signs of trauma

5 Physical exam

6 Vulvar hematomas

7 Vulvar hematoma Blood supply: –Pudendal artery –Posterior rectal artery –Transverse perineal artery –Posterior labial artery

8 Causes of injury Straddle injuries (75% of cases in peds) Sexual abuse Kicks Self-inflicted wounds

9 Vulvar hematoma Mgmt ?

10 Mgmt No further rapid expanse of hematoma Pain control Ice packs to groin Observe for ability to void D/W Gyne

11 Vulvar hematoma Kanai M et al. Warning from Nagano: increase of vulvar hematoma and/or lacerated injury caused by snowboarding. J Trauma. 50(20). 2001.

12 Mgmt Conservative –Small hematomas –No rapid expanse –Patient able to void Surgical –Large, rapidly expanding hematomas –Inability to void due to swelling –Infective complications

13 Mgmt Conservative mgmt: –Observation –Ice packs –Ice Sitz baths –Tetanus (if appropriate…)

14 Surgical mgmt I + D Ligation of bleeding arteries If suspected retroperitoneal hematoma: –Laparoscopy –Exploratory celiotomy

15 Imaging U/S ? Case report –Blunt straddle injury with L labial swelling and ++ pain –Transperineal U/S performed to more accurately measure size and extent of vulvar hematoma

16 U/S

17 CT

18 Summary Conservative mgmt if small, nonexpanding hematoma Involve Gyne if rapidly expanding, unable to urinate No role for imaging at this time…

19 Questions ?


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