COMPLICATIONS ASSOCIATED WITH THE ABSORPTION OF HYSTEROSCOPIC FLUID MEDIA

Objectives: To review the literature concerning complications resultin g from absorption of hysteroscopic fluid distension media and to descr ibe methods to treat and prevent these complications. Design: All pert inent literature on fluid distension media used for endoscopy, as well as relevant reports concerning the management of fluid and electrolyt e imbalance, was reviewed. Results: The absorption of large volumes of electrolyte-free, low-viscosity fluid may result in volume overload w ith water intoxication. Volume overload may cause pulmonary edema, and water intoxication may lead to hyponatremia, hypo-osmolarity, and cer ebral edema. In contrast, the absorption of dextran-70 may cause volum e overload secondary to the oncotic effect of intravascular dextran. D extran-70 has been associated with anaphylaxis and coagulation disorde rs. Treatment: The use of diuretics is advocated. Urine output must be closely monitored. Judicious correction of electrolyte imbalance will prevent morbidity. Prevention: Meticulous attention to intraoperative fluid balance is imperative. A multichannel hysteroscope is necessary to keep intrauterine pressure low. Extensive surgical procedures may need to be performed in stages. Conclusions: Severe volume overload an d electrolyte imbalance may result from fluid absorption during operat ive hysteroscopy. Most complications may be avoided by closely monitor ing fluid balance intraoperatively.