Sizable retrograde transtubal leakage of saline during bipolar hysteroscopic myomectomy: A potential cause of hypoxia: Retrograde transtubal leakage of saline during surgery

Atef Darwish; Leyla  Zubeydi; Dina  Darwish; Vefa  Dervis; Fathi F  Mohamed; Mohamed L  ElKhatib

doi:10.28982/josam.8078

Authors

Atef Darwish Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt https://orcid.org/0000-0003-0167-9337
Leyla Zubeydi Al Emadi Hospital, Doha, Qatar https://orcid.org/0009-0007-9291-7957
Dina Darwish Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt https://orcid.org/0000-0002-3976-8274
Vefa Dervis Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt https://orcid.org/0009-0008-2097-9355
Fathi F Mohamed Al Emadi Hospital, Doha, Qatar https://orcid.org/0000-0002-9983-8115
Mohamed L ElKhatib Al Emadi Hospital, Doha, Qatar https://orcid.org/0009-0002-2339-6610

DOI:

https://doi.org/10.28982/josam.8078

Keywords:

hypoxia, bipolar., hysteroscopy, myomectomy

Abstract

This case report discusses a bipolar hysteroscopic myomectomy procedure for a type II FIGO submucous myoma using 0.9% saline as a distension medium. Following the successful excision of the myoma, a significant decrease in oxygen saturation was observed, confirmed by blood gas analysis, urgent X-ray, and echocardiography. Despite the absence of acidosis or pulmonary edema, emergency abdominal ultrasonography revealed a large volume of intraperitoneal fluid. Approximately one liter of intraperitoneal saline was drained during an emergency laparoscopic intervention, leading to a notable improvement in the patient's hypoxia. This case highlights the importance of considering retrograde transtubal leakage of saline as a potential cause of intraoperative hypoxia, particularly in patients undergoing advanced hysteroscopic procedures with suspected patent fallopian tubes.

Downloads

Download data is not yet available.

References

Darwish AM, Ahmad AM, Mohammad AM. Cervical priming prior to operative hysteroscopy: a randomized comparison of laminaria versus misoprostol Human Reproduction 2004;19(10):2391-4. doi: 10.1093/humrep/deh397.

Darwish A. Modified hysteroscopic myomectomy of large submucous fibroids. Gynaecol Obstet Invest. 2003;56(4):192-6. doi: 10.1159/000074451

Darwish AM, Hassan ZZ, Attia AM, Abdelraheem SS, Ahmed YM. Biological effects of distension media in bipolar vs. monopolar resectoscopic myomectomy: A randomized trial Obstet Gynaecol Res. 2010 Aug;36(4):810-7. doi: 10.1111/j.1447 0756.2010.01244.x.

Peregrin-Alvarez I, Roman R, Christiansen ME, Ikwuezunma G, Detti L. Fluid deficit calculation at hysteroscopy: could consideration of intraperitoneal fluid accumulation add insight to safety limits? Minerva Ginecol. 2020 Dec;72(6):420-4. doi: 10.23736/S0026-4784.20.04640-7. Epub 2020 Oct 26. PMID: 33103407.

Chang YN, Zhang Y, Wang YJ, Wang LP, Duan H. Effect of hysteroscopy on the peritoneal dissemination of endometrial cancer cells: a meta-analysis. Fertil Steril. 2011 Oct;96(4):957-61. doi: 10.1016/j.fertnstert.2011.07.1146. Epub 2011 Aug 26. PMID: 21872230.

Palancsai Siftar J, Sobocan M, Takac I. The passage of fluid into the peritoneal cavity during hysteroscopy in pre-menopausal and post-menopausal patients. J Obstet Gynaecol. 2018 Oct;38(7):956-60. doi: 10.1080/01443615.2017.1420047.

Umranikar S, Clark TJ, Saridogan E, Miligkos D, Arambage K, Torbe E, et al. British Society for Gynaecological Endoscopy /European Society for Gynaecological Endoscopy Guideline Development Group for Management of Fluid Distension Media in Operative Hysteroscopy. BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy. Gynecol Surg. 2016;13(4):289-303. doi: 10.1007/s10397-016-0983-z.

Manchanda R, Valenti G, Rathore A, Carugno J, Török P, Riemma G, et al. Distension media delivery systems in hysteroscopy: past, present and future. Minim Invasive Ther Allied Technol. 2022 Jan;31(1):1-12. doi: 10.1080/13645706.2020.1763402. Epub 2020 May 15. PMID: 32410478.

Peregrin-Alvarez I, Roman R, Christiansen ME, Morris J, Detti L. Fluid deficit calculation at hysteroscopy in patients with and without tubal occlusion: could consideration of tubal passage change safety limits? Fertil Steril. 2019;112.3, suppl, E411.

Backer DD. Abdominal compartment syndrome. Crit Care. 1999;3(6):R103–4. doi: 10.1186/cc373. Epub 1999 Oct 13. PMCID: PMC137242.