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Interesting Case Rounds

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Presentation on theme: "Interesting Case Rounds"— Presentation transcript:

1 Interesting Case Rounds
Rebecca Burton-MacLeod R4, Emerg Med June 28th, 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 cont’d On examination: Hemodynamically stable
++ purplish-discolouration bulging mass to R labia; small laceration at 6 o’clock 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)

12 Mgmt Conservative Surgical 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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