Operative Hysteroscopy Intravascular Absorption Syndrome

Abstract

Operative hysteroscopy intravascular absorption (OHIA) syndrome ( < 1% ) is a complication of hysteroscopy which is caused by intravascular absorption of irrigating fluid medium during  hysteroscopic surgery. It is similar to urological transurethral resection of prostate syndrome (TURP syndrome), hence the alternative term gynaecological TURP syndrome.

                 We report a case of 27 year old patient undergoing hysteroscopic intrauterine septum resection under general anaesthesia who developed  pulmonary edema after one hour of surgery requiring emergency resuscitation. Serum estimation showed hyponatremia  (serum sodium: 130 mEq/l) which indicates absorption of irrigation fluid. Metabolic acidosis  suggested  glycine toxicity . OHIA syndrome was diagnosed and resuscitation started which included supportive measures mainly  mechanical ventilation to improve oxygenation , to  reduce extracellular volume and to correct  acid - base and electrolyte levels. The patient completely recoverd after treatment and discharged.

                Hysteroscopy usually has a low incidence of complications but absorption of irrigating fluid can results in fluid overload  and electrolye disturbances. Meticulous fluid balancing and minimizing  operation time may  prevent these life threatening complications.