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Interesting Case Rounds

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

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Interesting Case Rounds

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  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). 2001.

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

  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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