Pulmonary edema and hyponatremia after hysteroscopic uterine septectomy : A case report

The hysteroscope has become a standard part of gynecologists' armamentarium, and hysteroscopy is taught routinely in residency curriculums. In recent years, its use in gynecology has changed from a diagnostic tool only to an instrument for gynecologic operations. An electrolyte-free irrigation fluid is used for hysteroscopic surgery, and it has a possibility of substantial absorption of irrigation fluid. The absorption depends on the rate, volume and nature of the irrigation fluid. Fortunately, large-scale fluid absorption is rare but leads to symptoms severe enough to require intensive care. Several methods have been proposed to reduce the risk but none of them is capable of preventing the complication from fluid absorption. In this case, the patient had pulmonary interstitial edema with hyponatremia after hysteroscopic uterine septectomy but that had resolved without sequelae.

Dilutional hyponatremia developed during hysteroscopic myomectomy: A case report / 대한마취과학회지

Hysteroscopy is a procedure that may appear minimally invasive, but may result in potentially disastrous complications. A hysteroscopy requires the insertion of a hysteroscope into the uterine cavity and the installation of a suitable distention medium for the visualization of the endometrium. Fluid overload due to the absorption of distention media during hysteroscopy can cause mild to severe complications, including hyponatremia, hypoosmolarity, nausea, vomiting, headache, arrhythmia, blindness, confusion, seizure, cerebral edema, brain herniation, and death. We report a case of a 41 year-old female patient who underwent elective hysteroscopic myomectomy under general anesthesia. Approximately 4 hours after the beginning of the surgery, the patient's serum sodium concentration dropped to 109 mM. She was treated with furosemide and recovered without sequelae.

Asymptomatic Severe Dilutional Hyponatremia during Transurethral Resection of the Prostate: A case report / 대한마취과학회지

The transurethral resection of the prostate (TURP) syndrome is caused by intravascular absorption of an electrolyte-free irrigating fluid during TURP for benign prostatic hypertrophy or prostatic carcinoma. The clinical symptoms and signs include hypertension, bradycardia, respiratory distress, hypotension, nausea, vomiting, confusion, blindness, seizure, coma, hyponatremina, and hypoosmolality. In this case, we incidentally detected very severe dilutional hyponatremia (99 mmol/L) without any symptoms during TURP and immediately took measures to treat TURP syndrome. On the third postoperative day, the hyponatremia had resolved within the normal range.

Transurethral prostatectomy syndrome / 대한마취과학회지

A 70-year-old male was performed TURP (Transurethral resection of the prostate) under the diagnosis of benign prostate hyperplasia. Under general anesthesia, two times of TURP and suprapubic prostatectomy were performed for bleeding control during 8 hours. At the end of the operation, hypotension with bradycardia, severe ST elevation, QRS widening, T wave inversion and ventricular tachycardia on EKG appeared. Under the assumption of the diagnosis of hyponatremia, we treated with NaHCO3 and lasix, but cardiac arrest was followed by cardiopulmonary resuscitation. During postoperative five days, patient's cardiopulmonary status was supported by cardiotonic drugs and mechanical ventilation. We report this case to recall TURP syndrome and its management with the review of the relevant literatures.