Acute pulmonary edema during hysteroscopic myomectomy: A case of operative hysteroscopy intravascular absorption (OHIA) syndrome

Intraoperative complications during hysteroscopic procedures can lead to significant morbidity. This case illustrates a scenario where acute pulmonary edema developed as a result of excessive absorption of irrigation fluid. A 38-year-old woman with a history of three previous normal vaginal deliveries presented with abnormal uterine bleeding, and imaging revealed a submucosal fibroid measuring 20 × 19 mm 2 . She underwent hysteroscopic resection under general anesthesia. During the procedure, the patient developed abrupt desaturation accompanied by bilateral pulmonary crepitations, indicating acute pulmonary edema. Immediate interventions included mechanical ventilation with increased positive end-expiratory pressure, diuretics, corticosteroids, and fluid restriction. Surgery was converted to a vaginal hysterectomy. The patient was successfully extubated on the same day following stabilization. The importance of closely monitoring irrigation fluid balance during hysteroscopic procedures and taking prompt action when fluid overload issues occur is emphasized. This case also highlights limitations in fluid monitoring and acidosis management that contributed to the complication, underscoring the need for improved practices to prevent such events.