Introduction Operative hysteroscopy intravascular absorption (OHIA) syndrome is caused by intravascular absorption of fluid distension/irrigation medium during hysteroscopy. There are very few reported cases of this syndrome using saline as irrigation fluid. The current report was on a case of severe OHIA syndrome that necessitated resuscitation in an intensive care unit (ICU). Case Presentation A 41-year-old, 65-kg, smoker female patient was admitted for an endoscopic resection of submucous uterine myoma under general anesthesia using a laryngeal mask airway. In the 50th minute of the procedure, end-tidal CO 2 dropped from 35 to 25 mmHg and pulse oximetry (SpO 2 ) from 100% to 90%. Crackling sounds were heard from the base of the lungs. As a pulmonary oedema was suspected, the volume of irrigated saline was checked. A total of 4000 of the total 9000 mL of the saline had been absorbed into intravascular compartment. She developed a severe metabolic acidosis (pH 7.09) with severe hypokalemia (K + 2.3 mEq/L), hypocalcaemia (Ca 2+ 0.76 mEq/L), anemia (hemoglobin 5.3 g/dL), and hypothermia (tympanic temperature 33°C), as well as a generalized oedema with pulmonary and airway oedema. Due to airway oedema, she could only be intubated with a 6.5-mm tracheal tube. Resuscitation in the ICU was required. Electrolyte disturbances were corrected and furosemide was administered. She had a full recovery after 24 hours and 48 hours later, she was discharged. Conclusions Absorption of the irrigation fluid can result in life-threatening fluid overload. Accurate fluid balancing and limiting the operation time may prevent such complications. Therefore, early diagnosis and treatment of this syndrome is emphasized.

The study of T and B cells subsets showed a significant higher CD4 and CD19 levels in G2 at m2. NK cells count was significant lower in the same group at m3. There were no significant differences in the levels of immunoglobulin between groups. Conclusion: This study demonstrates that laparoscopic surgery appears to be associated with similar immune responses compared with open surgery, considering that immune parameters vary slightly between groups. Although higher CRP levels showed a high level of injury in the open surgery group, the management of perioperative care through an ERAS protocol seemed to minimise the effect of open surgery associated to more postoperative complications. Further studies are be required in order to clarify the significance of the different levels of CD4, CD19 and CD56 found among groups. Disclosure of interest: None declared.

The study of T and B cells subsets showed a significant higher CD4 and CD19 levels in G2 at m2. NK cells count was significant lower in the same group at m3. There were no significant differences in the levels of immunoglobulin between groups. Conclusion: This study demonstrates that laparoscopic surgery appears to be associated with similar immune responses compared with open surgery, considering that immune parameters vary slightly between groups. Although higher CRP levels showed a high level of injury in the open surgery group, the management of perioperative care through an ERAS protocol seemed to minimise the effect of open surgery associated to more postoperative complications. Further studies are be required in order to clarify the significance of the different levels of CD4, CD19 and CD56 found among groups.

No abstract

No abstract