Bleeding post lap. chole? - Forum

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forceps

Bleeding post lap. chole? - Ärzteforum

Post#1 »

40 year-old female underwent an uneventful laparoscopic cholecystectomy. Patient is discharge on post op. day#1.

Patient is re-admitted on post op day# 4 with chief complaint of right upper quadrant pain and shoulder pain (right). Abdomen soft, tender in RUQ. no peritoneal signs, BS+, BM+.

Hbg:9.4
wcc:7K

CT-Scann showed small peri hepatic collection.

Post op day# 5, Hbg: 8.7
Post op day# 6, Hbg: 7.9 Billi total: 1.6 Alk Phos: 300, pulse 80 BP 110/70, resp: 12. no orthopnea, urine output 300cc/8hs.

plan:

1- conservative: transfusion, diet, observe (for how long?)
repeat CT ? labs?

2- surgical: laparoscopy vs. open

I will appreciate any in-put on this case


User avatar
Surgeon

Re: Bleeding post lap. chole? - Ärzteforum

Post#2 »

I vote for observation. The collection on CT is described as small and there is no evidence of infection. I would NOT transfuse a 40 yr old patient with a hemoglobin of 7.9, but would closely observe and supplement iron. If ongoing bleeding is noted and /or CT shows a larger collection and /or evidnece of infection intervenes, then I might consider operative intervention.

Antibiotic

Re: Bleeding post lap. chole? - Ärzteforum

Post#3 »

Had two of these - never did discover where all the blood went!
Observe clinically and with ultrasound (cheaper than CT)
Probably will not need to transfuse.
Discharge when stable

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A Doctor

Re: Bleeding post lap. chole? - Ärzteforum

Post#4 »

What is the problem here? Patient is doing fine, and this hardly qualifies as "hemorrhage"! A bit of analgesia and go home! All will likely pass

Surrgeon

Re: Bleeding post lap. chole? - Ärzteforum

Post#5 »

Why supplement with iron when you know the blood must be somewhere in the abdomen and will eventually be broken down and reabsorbed, that is the iron should be reabsorbed also, so why give iron?

I had one of these several years ago in a young thin female--I assumed it was from trocar site bleeding. She did fine. Actually, I sent her home day after lap chole, before I got her Hgb back. At that time I was still doing next day hemoglobins. It was around 7.6. She didn't suffer any apparent adverse effects.

Ironically, I have another one now that went from 16.3 pre-op to 9.7 in 2 days. This is a 43 year old male, who is doing relatively well at the moment. I hadn't thought of ultrasound or CT--I don't know that anything I would find with either of these would alter my approach, which is to just wait and see.

सर्जन

Re: Bleeding post lap. chole? - Ärzteforum

Post#6 »

This lady is loosing at least one gram of her Hbg daily for the last three days, I would recommend selective hepatic artery angiography and embolisation of any bleeding point. As conservative or surgical approaches may be risky.

Jorjo

Re: Bleeding post lap. chole? - Ärzteforum

Post#7 »

No wonder that your patient bled,and she bled quite a bit. But now seems to be stabilized and will not need further lap or open exploration. This, I hope...My question is : How do you refer to the case as an uneventful op; usually when bleeding of a certain quantity takes place, the surgeon has, at least an idea, that there were difficulties during the vascular clipping or during the gallbladder disection from its hepatic bed.There was nothing to point out? When the exeresis of the gallbladder is finished, what are the parameters you demand in order to say : This was an uneventful surgery?

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