Catastrophic systemic reaction and fatal disseminated intravascular coagulation following high-pressure intrapelvic povidone-iodine instillation: A case report and review of possible mechanisms.

High-pressure intrapelvic instillation of povidone-iodine may result in catastrophic systemic complications, although such events are rarely reported. We describe a 52-year-old woman with genitourinary tuberculosis and a solitary functioning kidney who underwent augmentation cystoplasty with ureteric reimplantation. During surgery, dilute povidone-iodine was instilled through a percutaneous nephrostomy under high pressure to identify the ureteric orifice. Within minutes, she developed a catastrophic systemic reaction followed by disseminated intravascular coagulation, refractory shock, and death despite aggressive resuscitation and re-exploration. This case highlights the potential hazards of high-pressure intrapelvic antiseptic instillation and discusses possible underlying mechanisms.