Postoperative pulmonary edema and pulmonary hemorrhage following hysteroscopy

Hysteroscopic surgery, a minimally invasive technique prevalent in gynecology, exhibits an overall complication rate between 0.22% and 3.7%. Pulmonary bleeding post-hysteroscopy represents an exceedingly rare complication with only three reported cases to date; two involving high-viscosity solutions and one with hypertonicity solutions. Negative-pressure pulmonary hemorrhage, a seldomly encountered and lethal complication, manifests post-upper airway obstruction, with minimal documented cases, none within hysteroscopic procedures.

Regarding the case study, a 38-year-old female underwent hysteroscopic surgery and received 1600 milliliters of isosmotic low-viscosity uterine distension media (physiological saline) during the procedure. The patient experienced a transient upper airway obstruction lasting one minute due to anesthetic medication. 1 h after surgery, she exhibited positional coughing, expectorated pinkish diluted sputum, and displayed symptoms of hypoxemia. Physical examination revealed bilateral moist rales in the lung fields, while cardiac auscultation did not detect any abnormal murmurs. Diagnostic procedures included chest CT, echocardiography, and complete blood count. The chest CT illustrated diffusely reticular and patchy ground-glass opacities in both lungs, confirming the diagnosis of pulmonary edema with pulmonary bleeding. Treatment with dexamethasone and furosemide led to rapid improvement, meeting discharge criteria within 24 h post-surgery. Postoperative follow-ups showed no discomfort symptoms in the patient, with normal chest X-ray results.

In conclusion, the observed upper airway obstruction during hysteroscopic surgery seemingly reduced the safe absorption threshold of isosmotic uterine distension media. Therefore, gynecologists and anesthesiologists should remain vigilant about this potential complication.