Operative hysteroscopy intravascular absorption syndrome – a life-threatening complication
  • Tiago Neto Gonçalves
    Serviço de Medicina Interna, Hospital da Luz Lisboa, Lisbon, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
  • João Galaz Tavares
    Serviço de Medicina Interna, Hospital da Luz Lisboa, Lisbon, Portugal https://orcid.org/0000-0002-5395-5236
  • Natália Marto
    Serviço de Medicina Interna, Hospital da Luz Lisboa, Lisbon, Portugal
  • Cláudia Diogo
    Serviço de Medicina Intensiva, Hospital da Luz Lisboa, Lisbon, Portugal
  • António Messias
    Serviço de Medicina Intensiva, Hospital da Luz Lisboa, Lisbon, Portugal

Keywords

Hysteroscopy, pulmonary oedema, fluid overload, iatrogenesis

Abstract

Operative hysteroscopy intravascular absorption (OHIA) syndrome is a rare and potentially life-threatening complication related to irrigation fluid systemic absorption during hysteroscopy. It can lead to severe electrolyte disturbances, cerebral and pulmonary oedema, dysrhythmias and coagulopathy. We present the case of a 30-year-old woman who underwent a hysteroscopic myomectomy. After absorbing 2.5 l of normal saline, she experienced haemodynamic instability, respiratory distress and severe metabolic acidosis, initially mistaken for an anaphylactic or haemorrhagic shock. Insufficient monitoring of fluid deficit and irrigation fluid pressures contributed to the condition. This case underscores the importance of recognising OHIA and its risk factors to enable timely intervention and prevent adverse outcomes. Close fluid balance monitoring is vital in hysteroscopic surgeries to mitigate OHIA development.

VIEW THE ENTIRE ARTICLE

References

  • Munro MG, Christianson LA. Complications of hysteroscopic and uterine resectoscopic surgery. Clin Obstet Gynecol 2015;58:765–797.
  • Lee EB, Park J, Lim HK, Kim Y Il, Jin Y, Lee KH. Complications of fluid overload during hysteroscopic surgery: cardiomyopathy and epistaxis – a case report. Anesth Pain Med (Seoul) 2020;15:61–65.
  • Jackson S, Lampe G. Operative hysteroscopy intravascular absorption syndrome. West J Med 1995;162:53–54.
  • Wang MT, Chang CC, Hsieh MH, Chang CW, Fan Chiang YH, Tsai HC. Operative hysteroscopy intravascular absorption syndrome is more than just the gynecological transurethral resection of the prostate syndrome: a case series and literature review. Taiwan J Obstet Gynecol 2020;59:748–753.
  • Elegante M, Hamera J, Xiao J, Berger D. Operative hysteroscopy intravascular absorption syndrome causing hyponatremia with associated cerebral and pulmonary edema. Clin Pract Cases Emerg Med 2019;3:252–255.
  • Umranikar S, Clark TJ, Saridogan E, Miligkos D, Arambage K, Torbe E, et al. BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy. Gynecol Surg 2016;13:289–303.
  • Palancsai Siftar J, Sobocan M, Takac I. The passage of fluid into the peritoneal cavity during hysteroscopy in pre-menopausal and post-menopausal patients. J Obstet Gynaecol (Lahore) 2018;38:956–960.
  • Yoo SW, Ki MJ, Oh YJ, Kim T, Nam S, Lee J. Rapid correction of severe hyponatremia and control of subsequent overcorrection in operative hysteroscopy intravascular absorption syndrome: a case report. Medicine (Baltimore) 2022;101:e31351.
  • Singh S, Kumar N, Paul D, Sasidharan S. A case of operative hysteroscopy intravascular absorption syndrome: gynaecological TURP syndrome. Indian J Anaesth 2021;65:167–169.
  • de Freitas Fonseca M, Andrade CM, de Mello MJE, Crispi CP. Effect of temperature on fluidity of irrigation fluids. Br J Anaesth 2011;106:51–56.
  • Bergeron ME, Ouellet P, Bujold E, Cote M, Rhéaume C, Lapointe D, et al. The impact of anesthesia on glycine absorption in operative hysteroscopy: a randomized controlled trial. Anesth Analg 2011;113:723–728.
  • Munmany M, Gracia M, Nonell R, Cardona M, Pons M, Martin M, et al. The use of inhaled sevoflurane during operative hysteroscopy is associated with increased glycine absorption compared to intravenous propofol for maintenance of anesthesia. J Clin Anesth 2016;31:202–207.
  • Smith CC, Brown JPR. A case of cardiac arrhythmia from absorption of normal saline during hysteroscopic myomectomy. J Minim Invasive Gynecol 2019;26:770–773.
  • Views: 447
    HTML downloads: 57
    PDF downloads: 264


    Published: 2023-10-25
    Issue: 2023: Vol 10 No 11 (view)


    How to cite:
    1.
    Neto Gonçalves T, Galaz Tavares J, Marto N, Diogo C, Messias A. Operative hysteroscopy intravascular absorption syndrome – a life-threatening complication. EJCRIM 2023;10 doi:10.12890/2023_004132.

    Most read articles by the same author(s)