Transient acute liver failure complicating transurethral resection syndrome

Transurethral resection of the prostate (TURP) is a common procedure for treating benign prostatic hyperplasia. A known complication is TUR syndrome, caused by dilutional hyponatraemia from absorbed irrigation fluid. Ethanol is used in irrigation fluids to monitor absorption via breathalyser. Prior research has shown that excessive fluid absorption can lead to systemic toxicity, but liver failure as a complication is rare. No prior work had resolved whether ethanol-based irrigation fluids could directly cause hepatic injury. This uncertainty drove the need to examine cases where TUR syndrome was followed by unexpected liver impairment. The absence of clear evidence linking ethanol irrigation to liver damage left a gap in understanding potential TUR syndrome complications. While TUR syndrome is typically managed with fluid restriction and monitoring, this case suggests a need for additional diagnostic measures. The lack of prior documentation of ethanol-induced liver injury in TURP patients motivated further investigation. Understanding the mechanisms of TUR syndrome remains essential for improving patient safety protocols.

The aim of this case report is to describe an unusual instance of transient acute liver failure following TUR syndrome. The specific problem addressed is the potential link between ethanol-containing irrigation fluids and hepatic injury. The motivation stems from the absence of prior documentation of liver failure in TURP patients. This case highlights the importance of monitoring ethanol levels post-surgery. The authors sought to identify whether ethanol toxicity could be a novel complication of TUR syndrome. They aimed to demonstrate the need for improved diagnostic protocols during and after TURP. The study also aimed to inform surgeons about the potential for delayed hepatic toxicity. By reporting this case, the authors hoped to encourage further research into TUR syndrome complications.

The study is a single-case clinical report. The patient underwent TURP for benign prostatic hyperplasia. Ethanol was used in the irrigation fluid to monitor absorption via breathalyser. Fluid absorption was estimated at 2275 ml, exceeding the maximum allowed limit. The patient's condition was monitored for several hours post-surgery. Laboratory tests were conducted to assess electrolyte and organ function levels. The patient received intravenous acetylcysteine and furosemide for treatment. Follow-up assessments tracked recovery of liver and renal functions over 30 days. The case was analyzed to determine the likely cause of liver failure.

The patient developed acute liver failure approximately 10 hours after TURP. Laboratory results showed severe hyponatraemia (116 meq/l) and elevated liver enzymes (ALT 56,500 U/l, AST 32,700 U/l). Serum ethanol levels reached 219 mg/dl (0.2%) following surgery. Kidney function was also impaired (serum creatinine 1.93 mg/dl). Treatment with acetylcysteine and furosemide led to gradual improvement. Liver and renal functions returned to normal within 30 days. The authors suggest the liver injury may have been due to ethanol toxicity. The case highlights the potential for delayed hepatic complications in TUR syndrome.

The authors propose that ethanol toxicity may be a novel complication of TUR syndrome. They suggest that measuring ethanol levels post-surgery could help identify and prevent such complications. The case demonstrates the importance of monitoring beyond standard fluid absorption limits. The observed liver failure resolved completely within a month, indicating potential reversibility. The authors recommend routine ethanol level testing after TURP procedures. They emphasize the need for further studies to confirm this potential complication. The case suggests that ethanol-containing irrigation fluids may pose a risk to liver function. Surgeons should consider additional diagnostic measures to prevent delayed toxicity.