Anesth Pain Med.  2020 Jan;15(1):61-65. 10.17085/apm.2020.15.1.61.

Complications of fluid overload during hysteroscopic surgery: cardiomyopathy and epistaxis - A case report -

• Lee EB
• Park J
• Lim HK
• Kim YI
• Jin Y
• Lee KH

• KMID: 2500456
• DOI: http://doi.org/10.17085/apm.2020.15.1.61

Abstract

Background
Hysteroscopic surgery has been used in various gynecological fields. However, massive fluid overload can occur as a complication due to persistent infusion of media for uterine cavity distension. We present the case of a woman who developed cardiomyopathy with pulmonary edema and epistaxis during hysteroscopic surgery. Case: A 76-year-old female underwent hysteroscopic septectomy. She manifested abrupt, active nasal bleeding and regurgitation in the intravenous line. Heart rate, SpO2, and PETCO2 decreased from 55 beats/min to 29 beats/min, from 100% to 56%, and from 31 mmHg to 9 mmHg, respectively. After the operation, brain CT showed bilateral prominent superior ophthalmic vein dilation. Echocardiography showed left ventricle apical ballooning and global hypokinesia. The patient recovered after two days of conservative management, with no sequelae.
Conclusions
Although hysteroscopic surgery is a simple procedure, careful monitoring is necessary to prevent complications from absorption of fluid distending media during the procedure.

Keyword

Cardiomyopathy; Epistaxis; Hysteroscopy; Pulmonary edema

Figure

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  Fig. 1 Chest computed tomography shows dependent consolidation, ground glass opacity, and interlobular septal thickening in both lungs. Probable pulmonary edema or acute respiratory distress syndrome.

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  Fig. 2 Brain computed tomography. Superior ophthalmic vein was severely dilated (arrows), and no intracranial hemorrhage was found.

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  Fig. 3 Transthoracic echocardiographic apical 4-chamber view (endsystolic phase) findings in intensive care unit after hysteroscopic surgery. Left ventriclar dilation and global hypokinesia were observed. LV: left ventricle, RV: right ventricle.

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