Garcia Lawrence
A 66-year-old woman with end-stage renal disease in the setting of type 2 diabetes, hypertension, nephrolithiasis, and renal artery stenosis received a kidney transplant from a 7 year unrelated living donor before. She also had a history of chronic obstructive pulmonary disease, coronary artery disease, heart failure with preserved left ventricular ejection fraction, and atrial fibrillation (administration of rivaroxaban, an orally active factor Xa inhibitor oral for which she underwent ablation and atrio ventricular node placement a permanent pacemaker. She has excessive uterine bleeding. Test results showed a mass in the pelvis and uterus filled with fluid. She underwent elective hysteroscopy with dilation and curettage, which revealed a pyometra. The surgical process was complicated by bleeding and perforation of the uterus, requiring a total hysterectomy in the abdomen and bilateral salpingo-oophorectomy. She lost 300 mL of blood and received 3.2 liters of crystalloids during surgery. No intraoperative hypotension was noted. Pulse was also palpable in both lower extremities before and after surgery. The patient had anuria in the immediate postoperative period and furosemide (40 mg) was administered intravenously with no response. The patient was intubated because of acute respiratory failure and persistent anuria.
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