Endometrial Polyps and Postoperative Septic Shock in a Young Woman

A report describes a case of a 23-year-old woman with a BMI of 18.2 kg/m2 who was admitted due to the presence of endometrial polyps (EPs) that had been detected over six months ago. Prior examination of ovarian reserve function revealed low anti-Müllerian hormone (AMH) levels (<1 ng/ml), indicating primary ovarian insufficiency. The patient had regular menstruation and no history of pregnancy.

More than six months ago, she tested positive for mycoplasma, bacteria, and fungi in her vaginal discharge. Treatment with "nifuratel nystatin vaginal soft capsules and doxycycline hyclate tablets" successfully eradicated the mycoplasma and bacteria, but the fungal infection persisted. Subsequent treatment with "clotrimazole tablets" did not show any improvement. Fortunately, the fungal infection eventually cleared after receiving "fluconazole tablets." Consequently, the patient was admitted for hysteroscopic surgery, as she had been unable to conceive for over six months.

During the operation, a catheter was inserted into the uterine cavity, and 20 mL of physiological saline was injected without encountering any significant resistance, indicating unobstructed fallopian tubes. Hysteroscopy revealed the presence of five polyps within the uterine cavity, with the largest measuring approximately 0.8 cm x 0.5 cm and the smallest around 0.3 cm x 0.3 cm. All polyps were excised at their base using rotational movements of the inner blade, and the abraded fragments were aspirated and sent for pathological examination. The procedure was successfully completed within approximately eight minutes.

However, around three hours post-surgery, the patient developed mild lower abdominal pain, along with elevated body temperature (up to 38.7°C), heart rate (ranging from 92 to 120 beats per minute), respiratory rate (reaching 27 breaths per minute), and hypotension (approximately 72-83/35-54 mmHg). Laboratory examination indicated decreased white blood cell count, increased proportion of neutrophils, and significantly elevated infection markers, including hypersensitive C-reactive protein, procalcitonin, and interleukin levels. Considering the clinical manifestations and laboratory findings, the patient was diagnosed with postoperative septic shock. Consequently, she was transferred to the intensive care unit (ICU) and initiated on piperacillin-tazobactam combined with tinidazole for anti-infective treatment. Vasoconstriction was achieved using epinephrine, and the patient received fluid replacement and albumin supplementation. With treatment, the patient's condition gradually improved, characterized by stable vital signs, a progressive decline in white blood cell count, and normalization of infection markers. The blood culture obtained during this time yielded negative results. Subsequently, on the third day after the operation, she was transferred back to the gynecology ward. Following a 10-day course of antibiotic therapy, an abdominal ultrasound revealed a small amount of effusion. The patient's white blood cell count and various infection markers returned to normal before discharge.

Danna Su, Jiajie She, Ying Li et al. Case report: Septic shock after endometrial polypectomy with tissue removal system. 2023. PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-2665154/v1]