Hysteroscopic surgery represents a minimally invasive approach to the diagnosis and treatment of intrauterine pathologies. A distension fluid is required to provide visualization and hemostasis of the operative field. The use of a bipolar resectoscope enables the usage of electrolyte solutions, averting dilutional hyponatremia. However, fluid overload that can develop after the absorption of a sufficient amount of the irrigation medium is a complication to be feared.
We report a case of a 23-year-old female patient who developed acute symptomatic fluid overload and pulmonary edema without dilutional hyponatremia (140 mmol/L) secondary to hysteroscopic transcervical endometrial resection (TCER) for a uterine septum, where the distending medium was saline solution 0.9%.
Several precautions could be implemented to reduce the risk of fluid overload induced by the absorption of distention fluid. Namely, reducing the operative time, the flow, the total volume infused, the intrauterine pressure and strictly monitoring the absorbed volume. The instrumentation should support visual and auditory alarms. Moreover, all staff members should be acquainted with the clinical presentation and management, which mainly revolves around early identification. Therefore, regular simulated cases, to sharpen pathology-related knowledge and teamwork, should become standard practice.
Citation: Niccolò Stomeo, Giacomo Simeone, Leonardo Ciavarella, Giulia Lionetti, Arosh S. Perera Molligoda Arachchige, Francesco Cama. Fluid overload during operative hysteroscopy for metroplasty: A case report[J]. AIMS Medical Science, 2023, 10(4): 310-317. doi: 10.3934/medsci.2023024
Hysteroscopic surgery represents a minimally invasive approach to the diagnosis and treatment of intrauterine pathologies. A distension fluid is required to provide visualization and hemostasis of the operative field. The use of a bipolar resectoscope enables the usage of electrolyte solutions, averting dilutional hyponatremia. However, fluid overload that can develop after the absorption of a sufficient amount of the irrigation medium is a complication to be feared.
We report a case of a 23-year-old female patient who developed acute symptomatic fluid overload and pulmonary edema without dilutional hyponatremia (140 mmol/L) secondary to hysteroscopic transcervical endometrial resection (TCER) for a uterine septum, where the distending medium was saline solution 0.9%.
Several precautions could be implemented to reduce the risk of fluid overload induced by the absorption of distention fluid. Namely, reducing the operative time, the flow, the total volume infused, the intrauterine pressure and strictly monitoring the absorbed volume. The instrumentation should support visual and auditory alarms. Moreover, all staff members should be acquainted with the clinical presentation and management, which mainly revolves around early identification. Therefore, regular simulated cases, to sharpen pathology-related knowledge and teamwork, should become standard practice.
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Niccolò Stomeo, Giacomo Simeone, Leonardo Ciavarella, Giulia Lionetti, Arosh S. Perera Molligoda Arachchige, Francesco Cama. Fluid overload during operative hysteroscopy for metroplasty: A case report[J]. AIMS Medical Science, 2023, 10(4): 310-317. doi: 10.3934/medsci.2023024
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