Case Presentation
A twenty-six years P5L5 lactating female, status post total abdominal
hysterectomy (TAH) with bilateral salphingo-oohorectomy (BSO) on her
4th post-operative day presented to emergency with
complaints of paleness, documented fever of 103F without chills and
rigors for 2 days and bleeding from the surgical drainage site since
3rd postoperative day. She was referred from another
setting in the wake of an abrupt fall in hemoglobin percentage likely
due to massive bleeding from the drainage site due to slippage of
ligature and self-pullout of the drain. No other significant history was
noted at the time of admission. On examination, she appeared ill but was
conscious with well orientation to time, place and person and 15/15 on
the Glasgow Coma scale (GCS). Findings included pallor in the
conjunctiva and pale-looking skin, tachycardia with 128 bpm, regular,
tachypnea with 28 breaths/min, and a temperature of 100 F. Her abdominal
examination revealed a non-distended abdomen with a midline vertical
incision on the lower abdomen, clean without pus or inflammation, with a
drain site that was soggy and tender, and without any significant CNS,
CVS or respiratory system findings. [Fig.1]. She had
undergone elective TAH with BSO for a single hypoechoic lesion of
32.88mm at the left adnexa [Fig.2,3]. At ER, she was
managed with IV antibiotics, antipyretics, PPI and one pint of whole
blood transfusion, the blood and urine samples were sent for further
investigations. The detailed compared laboratory findings of the patient
at the time of admission to that before the surgery is tabulated in