Surgical Complications

Question 1

Difference between early onset and late onset trochar hernias

Answer 1

Early onset - occur within 2-12 days of surgery w/ a painful bulge at the trocar site; DO NOT contain peritoneum. Usually contain small bowel and can cause obstruction.
Late onset - diagnosed between 13-30 days, typically contain only peritoneum and present as a painless bulge at the trocar site

Question 2

How do you manage uterine perforation during a hysteroscopy?

Answer 2

If midline fundal perforation with blunt instrument and minimal bleeding - can be observed
Lateral injuries warrant further evaluation
Perforation with anything sharp/thermal etc warrants evaluation

Question 3

Define SIRS, sepsis, severe sepsis, and septic shock

Answer 3

SIRS - need 2 or more of the following (fever or hypothermia, RR > 20, WBC >12K or <4K, and HR > 90)
Sepsis - SIRs with an infection
Septic shock - Sepsis with end organ dysfunction or elevated lactate
Septic shock - Sepsis with HYPOTENSION