Acute respiratory distress syndrome after conization: a case report

Abstract

Introduction: Conization of the cervix is a surgical procedure used to treat or diagnose cervical dys­plasia. The definition is: excision of a cone-shaped or cylindrical wedge from the cervix uteri that in­cludes the transformation zone and all of or a portion of the endocervical canal. Conization can be performed with a scalpel (cold-knife conization), laser or electrosurgical loop. Complications are rare. Materials and Methods: On the same day after successful conization due to cervical carcinoma in situ, a 37-year-old woman presented clinical manifestation of acute respiratory failure. She was admitted to the Intensive Care Unit in Dobrich Hospital and an endotracheal intubation was performed. After consultation with the Regional anesthesia consultant and intensive care, a decision was taken to ad­mit the patient to the intensive care unit in the University Hospital `St. Marina` Varna. The patient was transported there, on the next day. Results: Full examination was performed and the diagnosis was sepsis with ARDS as a complication. The patient was treated with parenteral Meropenem, Metronidazole, Azithromycin, Fluconazole, in­travenous fluids, inotropic agents, and heparin. Muscle relaxants and Midazolam were used for syn­chronization between the ventilator and the patient and achieving better oxygenation. From the vag­inal secretion Candida glabrata was isolated. On the eight day after hospitalization a tracheostomy was performed. Gradually the condition of the patient showed improvement and she recovered com­pletely and left the clinic after 18 days. Conclusion: Conization complications are intraoperative or post-operative bleeding, cervical steno­sis, cervical insufficiency, infection and sepsis. Generally they are relatively rare. Sepsis and extrapel­vic infections are extremely rare complications of cervical conization. Most complications are expect­ed after conization performed with a scalpel rather than with a laser.