Interesting Case Rounds

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Presentation transcript:

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

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

History Any other questions you wish to ask?

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

Physical exam

Vulvar hematomas

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

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

Vulvar hematoma Mgmt ?

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

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.

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

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

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

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

U/S

CT

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

Questions ?