Septic shock following hysteroscopy - A case report

Abstract

Introduction: Minimally invasive gynecological surgery such as hysteroscopy has a small risk of complications. These include uterine perforation (with or without adjacent pelvic organ lesion), bleeding and infection, and are more common in the presence of risk factors such as smoking, history of pelvic inflammatory disease (PID) and endometriosis.

Case presentation: A patient submitted to a diagnostic hysteroscopy with no immediate complications was admitted five days later to the emergency department in septic shock. The diagnosis of ruptured tubal abscess was made, requiring emergency laparotomy with sub-total hysterectomy and bilateral adnexectomy. Despite multiple organ failure requiring admission to the intensive care unit, the patient made a full recovery.

Conclusion: Ascending infection can be a life-threatening complication of hysteroscopy, even in the absence of previously known risk factors.

Keywords: Complications; Hysteroscopy; Multiple organ failure; Risk factors; Sepsis.

Fig. 1

Vaginal ultrasound performed in the Emergency Department, showing a 13-centimeter anechoic mass adjacent to the ovary, suggestive of fallopian tube collection.

Fig. 2

Abdominal X-ray showing distension of gastric chamber and initial portion of small bowel, with no signs of pneumoperitoneum.

Fig. 3

Computerized tomography (CT) scan, highlighting the presence of a large pelvic mass involving the uterus and right fallopian tube.