Nithiyananthan Murugananth, Shah Shitalkumar Sharad, Suhitharan Aarthi, Thangavelautham Suhitharan
Singapore General Hospital, Singapore, Singapore.
National Junior College, Singapore, Singapore.
J Crit Care Med (Targu Mures). 2025 Jul 31;11(3):301-306. doi: 10.2478/jccm-2025-0027. eCollection 2025 Jul.
Holmium Laser Enucleation of the Prostate (HoLEP) is a widely used minimally invasive surgical technique for benign prostatic hyperplasia (BPH), offering advantages such as reduced bleeding, shorter hospitalization, and elimination of TURP syndrome. However, complications related to fluid absorption and capsular perforation can still occur. We report a rare case of severe refractory metabolic acidosis and acute abdominal compartment syndrome (ACS) following HoLEP.
A 74-year-old male with diabetes and hypertension underwent HoLEP for a 180-ml prostate, during which 106 liters of normal saline irrigation were used over three hours. Intraoperatively, the patient developed sudden respiratory distress and hypotension, with arterial blood gas analysis revealing severe metabolic acidosis (pH 7.141, HCO 11 mEq/L, Cl 115 mEq/L), primarily due to excessive saline absorption and hyperchloremia. The patient required intubation, vasopressor support, and emergency dialysis due to worsening hemodynamic instability. Postoperative imaging revealed intra-abdominal fluid collection, which was drained percutaneously. After two days of intensive ICU management, the acidosis resolved, and the patient was successfully extubated.
This is the first case highlighting the potential risks of normal saline absorption and the effect of capsular perforation, which caused ACS and refractory acidosis, and required CRRT due to the prolonged duration of HoLEP.
钬激光前列腺剜除术（HoLEP）是一种广泛应用于良性前列腺增生（BPH）的微创手术技术，具有出血少、住院时间短和避免经尿道前列腺电切综合征等优点。然而，与液体吸收和包膜穿孔相关的并发症仍可能发生。我们报告一例HoLEP术后罕见的严重难治性代谢性酸中毒和急性腹腔间隔室综合征（ACS）病例。
一名74岁患有糖尿病和高血压的男性因180毫升前列腺增生接受HoLEP手术，术中3小时使用了106升生理盐水冲洗。术中，患者突然出现呼吸窘迫和低血压，动脉血气分析显示严重代谢性酸中毒（pH 7.141，HCO 11 mEq/L，Cl 115 mEq/L），主要原因是过量吸收生理盐水和高氯血症。由于血流动力学不稳定恶化，患者需要插管、血管活性药物支持和紧急透析。术后影像学检查显示腹腔积液，经皮引流。经过两天的重症监护病房强化治疗，酸中毒得到缓解，患者成功拔管。
这是首例突出显示生理盐水吸收潜在风险以及包膜穿孔影响的病例，该病例导致了ACS和难治性酸中毒，且由于HoLEP手术时间延长而需要连续性肾脏替代治疗（CRRT） 。
