Intravascular absorption syndrome : case report of a life-threatening complication during hysteroscopy

Abstract

A 40-year old, healthy woman underwent hysteroscopic endometrial ablation with a bipolar electrocautery using 0.9% saline as distension fluid. After 45 minutes of surgery, arterial oxygen saturation decreased and liquid was obstructing the laryngeal mask. With an estimated total fluid deficit of 5000 mL, fluid overload was suspected and the patient’s trachea was intubated. Furosemide was given intravenously and a urinary catheter was inserted. The intra-abdominal pressure, measured through the urinary catheter, was 28 mmHg. As ventilation became unfeasible, the patient became cyanotic and no clear pulse could be detected, cardiopulmonary resuscitation was started. In order to decrease the abdominal pressure, a laparotomy was performed and extracorporeal membrane oxygenation was started to increase the arterial oxygenation. After one week in the Intensive Care Unit, the patient was extubated and gradually recovered without further complications nor residual morbidity.

The pathophysiological aspects of the evolution to severe pulmonary edema due to massive fluid translocation during operative hysteroscopy, and the rationale behind the successful interventions are being discussed. Close continuous monitoring of the amount of fluid deficit should be performed to avoid severe fluid overload during operative hysteroscopy. Extracorporeal membrane oxygenation can be life-saving to bridge the period of desaturation until standard treatment suffices to provide adequate oxygenation.