Carbon monoxide poisoning, gas embolism and fluid overload during resectoscopic myomectomy

Resectoscopic myomectomy (RM) is a standard minimally invasive procedure but carries risks of distinct complications. We report a rare case of a 36-year-old woman who simultaneously developed a triad of life-threatening complications during HM: carbon monoxide poisoning, gas embolism, and fluid overload. The patient presented with precipitous drops in end-tidal carbon dioxide and bispectral index silence. Arterial blood gas analysis revealed severe metabolic acidosis, electrolyte disturbances, and a carboxyhemoglobin level of 27.1%. Definitive diagnosis via arterial blood gas analysis and subsequent multimodal management, bolstered by the patient's excellent physiological reserve, led to a full recovery. This case highlights the critical need for strict fluid management during RM and CO-oximetry's indispensable role in detecting concurrent carbon monoxide toxicity.