Abstract
Hysteroscopic myomectomy is indicated for symptomatic submucosal uterine fibroids. The main complications associated with the procedure are uterine perforation and water intoxication. This report details a case of water intoxication that presented with acute hyponatremia during hysteroscopic myomectomy. The procedure was suspended and the patient's electrolyte imbalance was managed in the intensive care unit (ICU).
The patient was a 36-year-old nulligravid female with a history of hypermenorrhea and a 6cm submucosal myoma with 100% protrusion from the uterine fundus. Excision of the tumor by laparoscopy combined with hysteroscopic myomectomy was attempted to preserve the uterus. At three hours and thirty minutes into the procedure, the patient's blood pressure dropped to 70/40mmHg. Infusion volume was 15,000ml and drainage was 12,000ml. An immediate electrolyte panel revealed severe hyponatremia, with a serum sodium level of 96mEq/l. The operation was suspended and the patient was transferred to the ICU. She left the ICU the next day with a serum sodium level of 132mEq/l. On the 6th post-operative day, she was discharged without significant sequelae. The size of the remaining myoma on follow-up ultrasound was 3cm, but a repeat hysteroscopy revealed that the intrauterine protrusion had receded. After six months, the patient underwent open myomectomy.
This case suggests that operative duration in hysteroscopy should be less than 2 hours to avoid water intoxication. In addition, infusion and drainage volumes must be monitored, with special attention required when the difference between the two volumes exceeds 750ml. The operation should be suspended when the difference exceeds 1500ml.
