Acute Severe Hyponatremia following Hysteroscopic Procedure in a Young Patient: A Case Report and Review of the Literature

Background. Hysteroscopic surgery is a minimally invasive procedure used to diagnose and treat intrauterine pathologies. It requires distension of the uterine cavity for the adequate visualization of the operative field. Glycine (1.5%) is one of the most commonly used solutions because it is nonconductive and also has good optical properties. However, acute hyponatremia is a critical complication that can develop after the absorption of a sufficient amount of the irrigation medium. Case Presentation. We report a case of a 43-year-old female patient who developed acute symptomatic hyponatremia (104 mEq/L) and pulmonary edema secondary to hysteroscopic resection of leiomyoma and hastily approached with rapid sodium correction measures. Conclusion. Multiple strategies can be taken to reduce the risk of fluid absorption and subsequent hyponatremia. Moreover, attention should be paid to the treatment approach for patients with acute hyponatremia following hysteroscopic procedures; rapid correction of acute hyponatremia for such patients might be safe, although there is no consensus in the literature, and further trials are needed.

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Hysteroscopic evaluation in infertility and abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180181 ◽

2018 ◽

Vol 7 (2) ◽

pp. 612

Author(s):

Navneet Kaur ◽

Ruby Bhatia ◽

Paramjit Kaur ◽

Surinder K. Bhopal

Keyword(s):

Endometrial Hyperplasia ◽

Uterine Cavity ◽

Invasive Procedure ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Therapeutic Modality ◽

Secondary Infertility ◽

Endometrial Polyps ◽

Submucous Fibroid

Background: Hysteroscopy an endoscopic procedure for visualization of uterine cavity may be extensively used in both primary and secondary infertility and abnormal uterine bleeding for evaluating intrauterine pathology. The objectives of this study were to visualize and identity intrauterine pathology in both primary and secondary infertility and abnormal uterine bleeding (AUB) by hysteroscopic evaluation and to perform hysteroscopic guided therapeutic procedures like endometrial currettage, polypectomy, adhesiolysis.Methods: Hysteroscopic evaluation of uterine cavity for any intrauterine pathology in AUB and Infertility. Adhesiolysis, polypectomy, endometrial biopsy misplaced copper T removal were carried out under hysteroscopic vision.Results: Intrauterine synechia in 20.51%, Submucous fibroid in 5.13%, bicornuate uterus, endometrial hyperplasia and endometrial polyp were seen in 2.56% patient each were detected in infertility group while 81.95% cases with AUB had abnormal intrauterine pathology commonest being endometrial hyperplasia in 33.33% followed by endometrial polyps in 23.81% cases, submucous fibroid and misplaced copper T in 9.52% each and intrauterine synechia in 4.76% patient. Endometrial biopsy and polypectomy was done in 23.80% each with AUB, misplaced copper T removal in 9.52% and adhesiolysis in 4.76% patient with AUB.Conclusions: Hysteroscopy remains gold standard for evaluating intrauterine lesions in abnormal uterine bleeding and infertility. A safe, simple minimally invasive procedure not only diagnostic but therapeutic modality for adhesiolysis, endometrial biopsy/curettage, polypectomy, misplaced copper T removal under direct vision with minimal complication within reach of every Gynaecologist thereby reducing burden of major surgical intervention.

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DO REPRODUCTIVE AND OBSTETRIC OUTCOMES AFTER HYSTEROSCOPIC SURGERY FOR DYSMORPHIC UTERUS DIFFER FROM THOSE OF PATIENTS WITH NORMAL UTERINE CAVITY?

Fertility and Sterility ◽

10.1016/j.fertnstert.2020.08.1366 ◽

2020 ◽

Vol 114 (3) ◽

pp. e475

Author(s):

Umut Göktürk ◽

Semra Kahraman ◽

Hacer Uyanikoglu

Keyword(s):

Uterine Cavity ◽

Obstetric Outcomes ◽

Hysteroscopic Surgery

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Desmopressin to Prevent Rapid Sodium Correction in Severe Hyponatremia: A Systematic Review

The American Journal of Medicine ◽

10.1016/j.amjmed.2015.04.040 ◽

2015 ◽

Vol 128 (12) ◽

pp. 1362.e15-1362.e24 ◽

Cited By ~ 23

Author(s):

Thomas E. MacMillan ◽

Terence Tang ◽

Rodrigo B. Cavalcanti

Keyword(s):

Systematic Review ◽

Severe Hyponatremia ◽

Sodium Correction

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Cervical osteomyelitis and an epidural abscess: an unusual form of cat-scratch disease in one case

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-021-00119-9 ◽

2021 ◽

Vol 36 (1) ◽

Author(s):

Hamid Khay ◽

Salvatore Chibbaro ◽

Younes Dehneh ◽

Helene Cebula ◽

François Proust

Keyword(s):

Marked Improvement ◽

Epidural Abscess ◽

Treatment Approach ◽

Bartonella Henselae ◽

Cord Compression ◽

Cat Scratch Disease ◽

Systemic Complications ◽

Case Presentation ◽

Bone Damage ◽

Therapeutic Attitude

Abstract Background The association of cervical osteomyelitis with epidural abscess is extremely rare; atypical symptomatology is what makes diagnosing and management challenging. This case is the sixth case reported in the literature. The objective of our study is to describe the clinical manifestation and treatment approach. Case presentation A 71-year-old male with no medical history, who was admitted to the emergency room for C7-T1 spinal cord compression caused by Bartonella henselae, marked improvement after decompression by evacuating the empyema and antibiotic course. Conclusion Cat-scratch disease or subacute regional lymphadenitis is a bacterial infection caused by Bartonella henselae; children and adolescents are mostly infected. Systemic complications are rare; the prevalence of bone damage is estimated at 0.1 to 0.3%. Our case allows a literature review of and put in focus on our diagnostic and therapeutic attitude.

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A petevezeték-átjárhatóság vizsgálómódszereinek összehasonlító elemzése

Orvosi Hetilap ◽

10.1556/650.2017.30653 ◽

2017 ◽

Vol 158 (9) ◽

pp. 324-330 ◽

Cited By ~ 1

Author(s):

Judit Lőrincz ◽

Attila Jakab ◽

Péter Török

Keyword(s):

Direct Method ◽

Standard Procedure ◽

Abdominal Cavity ◽

Uterine Cavity ◽

Invasive Procedure ◽

Cost Effective ◽

Fallopian Tubes ◽

Predictive Values ◽

Tubal Patency ◽

First Choice

Abstract: Most common organic cause of infertility is the blockage of the Fallopian tubes. Several methods were introduced to evaluate tubal patency. Hysterosalpingography is a conventional radiology procedure using contrast medium, which gives an accurate image of the uterine cavity and the Fallopian tubes, but radiation exposure is necessary. Hystero-contrast-sonography similarly examines the uterine cavity and tubal patency by ultrasonography, and it enables to detect pelvic pathology, too. Transvaginal hydrolaparoscopy is a minimal invasive direct method using endoscope introduced into the abdominal cavity through the posterior vaginal fornix, both ovaries and tubal patency can be observed. Laparoscopy is the “gold standard” procedure in the tubal testing, however it is a more invasive procedure. A cost-effective testing method is the selective tubal pertubation performed via office hysteroscopy. Recent outpatient methods to detect tubal patency have high negative predictive values and recommended to be the first choice in infertility work-up. Orv. Hetil., 2017, 158(9), 324–330.

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The elusive diagnosis and emergent management of a late-presenting ruptured interstitial pregnancy: a case report

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04026-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lauren M. Ahlschlager ◽

David Mysona ◽

A. Jenna Beckham

Keyword(s):

Uterine Cavity ◽

Exploratory Laparotomy ◽

First Trimester ◽

Intrauterine Pregnancy ◽

Case Presentation ◽

Interstitial Pregnancy ◽

Fertility Sparing ◽

Missed Diagnosis ◽

Poor Outcomes ◽

First Trimester Ultrasound

Abstract Background Interstitial pregnancies are rare and often difficult to diagnose given their proximal position to the uterine cavity, however most are identified by 12 weeks gestation. Delayed or missed diagnosis contributes to heightened incidence of poor outcomes including hemorrhage and death. Case presentation A 35-year-old woman at 15 weeks gestation with confirmed intrauterine pregnancy on first trimester ultrasound and prior negative MRI presented in hemorrhagic shock and was found to have a ruptured interstitial pregnancy. Exploratory laparotomy revealed the fetus to be in the abdomen as well as a large cornual defect and abnormal placentation that resulted in supracervical hysterectomy. Conclusions Interstitial pregnancy should be considered in a patient presenting with symptoms consistent with ectopic rupture, especially in the setting of equivocal or suboptimal prior imaging. Earlier diagnosis may allow for fertility-sparing intervention and decreased risk of morbidity and mortality.

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Comparison Between 200 μg and 800 μg of Misoprostol for Cervical Ripening Prior to Operative Hysteroscopy: A Study Protocol for A Randomized Controlled Trial.

10.21203/rs.3.rs-35465/v1 ◽

2020 ◽

Author(s):

Maria da Conceição Farias Souto Maior ◽

Aurélio Antônio Ribeiro Costa ◽

Alex Sandro Rolland Souza

Keyword(s):

Study Protocol ◽

Controlled Trial ◽

Uterine Cavity ◽

Invasive Procedure ◽

University Teaching ◽

Cervical Dilatation ◽

Cervical Ripening ◽

Teaching Hospitals ◽

Cervical Canal ◽

Operative Hysteroscopy

Abstract Background: Hysteroscopy, a minimally invasive procedure, has been increasingly used to treat disorders of the cervical canal and uterine cavity. However, difficulties related to the insertion of the hysteroscope through the cervical canal still remain. Although there are reported advantages in reducing cervical resistance with the use of misoprostol for cervical ripening, systematic reviews highlight the need to determine the optimal dose. This study was designed to compare two groups of patients submitted to cervical dilatation prior to operative hysteroscopy and pre-treated with either 200 µg or 800 µg of misoprostol for cervical ripening. Methods: A randomized, quadruple-blind clinical trial with patients submitted to cervical dilatation prior to operative hysteroscopy at university teaching hospitals in Recife, Pernambuco, Brazil. After the internal review boards of the participating institutes had approved the study protocol, data collection began on November 7, 2019, with expected completion on November 1, 2020. Patients included in the study following the informed consent process are randomly allocated to one of two groups, the first allocated to use 200 μg misoprostol and the second to use an 800-μg dose. In both groups, misoprostol will be administered vaginally 10-12 hours prior to operative hysteroscopy. The groups will be compared in relation to intraoperative and postoperative outcomes based on the following endpoints: baseline cervical dilatation, cervical length, degree of difficulty, duration of cervical dilatation, failure to dilate, adverse events and surgical complications. The chi-square test of association, Fisher's exact test and the Mann-Whitney test will be used to compare the groups, with an alpha error of <5% being considered significant. Discussion: The findings of this study will contribute towards establishing the optimal misoprostol dose for cervical ripening prior to operative hysteroscopy, ultimately facilitating hysteroscope insertion through the cervical canal. A gap will be filled in the currently available literature, providing future preoperative guidance. The 800-μg dose of misoprostol is expected to reduce resistance in the cervix and shorten the time until achieving cervical dilatation, delivering a less traumatic procedure for the patient. Therefore, the study is relevant for surgeons in this field, for the scientific community and, particularly, for patients. Trial registration: Clinical Trials Register: NCT04152317. Registered on November 5, 2019. URL https://clinicaltrials.gov/ct2/show/study/NCT04152317.

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Myomectomy scar pregnancy ‒ a serious, but scarcely reported entity: literature review and an instructive case

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2021-0071 ◽

2022 ◽

Vol 0 (0) ◽

Author(s):

Marcela Toro-Bejarano ◽

Robert Mora ◽

Ilan E. Timor-Tritsch ◽

Jessica Vernon ◽

Ana Monteagudo ◽

...

Keyword(s):

Uterine Cavity ◽

Pregnancy Complication ◽

Reproductive Age ◽

Case Presentation ◽

Clinical Appearance ◽

Uterine Myomas ◽

Placental Site ◽

Relative Rarity ◽

Placenta Accreta Spectrum ◽

Us Scan

Abstract Objectives Uterine myomas are a frequent finding in reproductive age women with an estimated incidence 12–25%. 1. Treatment of uterine myomas to facilitate good pregnancy rates and outcome, such as hysteroscopic, laparoscopic, abdominal resection uterine artery embolization among others were evaluated in terms of pregnancy outcome. While the literature is replete of the pregnancy complication of uterine rupture after myomectomies, 2–4 there are very few publications evaluate a relatively rare pregnancy complication associated with placental implantation within the uterine cavity at the site of the previous myomectomy, namely the myomectomy scar pregnancy (MSP). Despite their relative rarity, this type of pathologically adherent placenta rightfully belongs to the well-known entity of placenta accreta spectrum (PAS). Case presentation We present a complicated case of MSP and review the available literature to raise attention to its clinical appearance, its prenatal diagnosis so appropriate intrapartum management can be planned. Conclusions Despite the rarity of MSP, continuous attention should be given at every single routinely scheduled or indication driven obstetrical US scan following myomectomies to evaluate the placental site implantation regardless of the route and technique of their initial surgical procedure.

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Evaluation of endometrial thickness with transvaginal ultrasonography in perimenopausal women presenting with abnormal uterine bleeding and correlation with its histopathological findings

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194882 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4496

Author(s):

Noor Ayesha Begum ◽

Lokesh Chandra H. C. ◽

Ravindra S. Pukale

Keyword(s):

Endometrial Thickness ◽

Uterine Cavity ◽

Invasive Procedure ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Transvaginal Ultrasonography ◽

Common Finding ◽

Histopathological Findings ◽

Perimenopausal Women

Background: Abnormal uterine bleeding is the most common presenting menstrual complaint in women of perimenopausal age group. Most frequently used diagnostics tests to investigate the causes of abnormal bleeding are Transvaginal ultrasonography (TVS) and endometrial biopsy. Uterine curettage is an invasive procedure and is performed with anaesthesia. TVS is a non-invasive method that has been used to evaluate the endometrium and uterine cavity. The objectives of this study were to measure and evaluate the role and accuracy of endometrial thickness by transvaginal ultrasonography study to detect endometrial pathology in perimenopausal women presenting with Abnormal Uterine Bleeding. To correlate the transvaginal sonographic results with the Histopathological findings to discriminate normal from pathological endometrium.Methods: Prospective study including 150 perimenopausal women with abnormal uterine bleeding. Endometrial thickness was measured by TVS and then D and C was performed for all the patients.Results: Out of 150 women, 128 (85.3%) had normal and 22 (15%) had an abnormal endometrium. 43.3% were of 41-45 years and 65.3% patients presented with complaint of heavy menstrual bleeding. Majority of the patients in the study group were para 2 or more. Fibroid uterus (24%) was the commonest uterine pathology detected on TVS. 53.3% of patients had endometrial thickness in the range 10-14.9 mm. Most common finding on HPE was secretory endometrium (44.6%). Endometrial carcinoma was found in 3%. Endometrial thickness <14mm was associated with least abnormal endometrial pathology.Conclusions: Endometrial thickness of less than 14 mm need not be indicated for D and C in perimenopausal abnormal uterine bleeding. In perimenopausal women with AUB, TVS should be the investigation of choice due to its convenience, accuracy and non- invasiveness.

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