Diagnosing Excessive Irrigation Fluid Intravasation During Operative Hysteroscopy: A Case Report

Abstract

Excessive irrigation fluid intravasation is a rare but potentially life-threatening complication of operative hysteroscopy.

A 46-year-old woman underwent hysteroscopic endometrial polypectomy under general anesthesia using normal saline as the uterine distension medium. During surgery, an abrupt decrease in end-tidal carbon dioxide accompanied by progressive oxygen desaturation prompted a broad differential diagnosis, and subsequent arterial blood gas analysis revealed severe hyperchloremic metabolic acidosis and marked hemodilution. Integration of physiological changes, arterial blood gas abnormalities, and intraoperative findings led to the diagnosis of massive irrigation fluid intravasation, resulting in prompt termination of the hysteroscopic procedure. The patient recovered without major complications.

This case highlights the value of integrating physiological monitoring, arterial blood gas analysis, and intraoperative findings for timely diagnosis of excessive irrigation fluid intravasation during operative hysteroscopy.

Keywords: Hysteroscopy; Fluid Intravasation; Normal Saline; Pulmonary Edema

Citation

Kim NY, Kim KN. Diagnosing Excessive Irrigation Fluid Intravasation During Operative Hysteroscopy: A Case Report. WebLog J Anesthesiol. wjan.2026.h1505. https://doi.org/10.5281/zenodo.21948198