My thanks for any help on this case.
My urgent consult was obtained from Dr. XXX during urgent primary cesarean section. She says that once she finished closing the uterine incision and had begun to reapproximate the fascia she noticed a moderate amount of bleeding and it was difficult to identify the ultimate source. I did place an Alexis-O retractor to be able to better visualize the uterus and fallopian tubes as well as the bowel. She was found to have a 5×7 left broad ligament hematoma. This was oozing out of a tear near the attachment of the fimbriated end of the fallopian tube to the ovary. Inspection of the left corner of the uterine incision did have some oozing as well with mobilization of the uterine vessels laterally. I did place several figure-of-eight sutures in the corner of the uterine incision. This did dry up the bleeding nicely. The defect in the broad ligament near the uterine ovarian ligament that had been torn was oozing was reapproximated with 2-0 Vicryl. The hematoma was well organized by the time of my exam and did not appear to be enlarging. This was observed for several minutes and did not change.
Attention was turned to the right side. She did have small paratubal cyst as well as some oozing from what looked like a defect of a portion of the fimbriated ends of the fallopian tube on the left side. This was grasped across with a Kelly clamp, just the bleeding portion separate from the remainder of the abnormal appearing fallopian tube. The bleeding portion was clamped across with a Kelly and tied off with a 0 Vicryl. this resulted in hemostasis. The bowel was inspected. It appeared to be without surgical injury. The bowel was packed away. the uterus did appear to be firm after several minutes of inspection, really minimal oozing and no active bleeding were noted. Hematoma appeared to be stable. The case was then turned back over to Dr. XXX.