Cervical Diverticulum – Hysterosalpingography
Cervical diverticulum is a rare benign outpouching of the cervical canal wall. It may be congenital or acquired, commonly related to trauma, infection, prior cervical surgery, or obstetric injury. On hysterosalpingography (HSG), cervical diverticulum appears as a contrast-filled saccular or tubular outpouching arising from the cervical canal, which may retain contrast on delayed images (Fig. 1).
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| Fig-1 |
Findings: A localized saccular contrast collection communicates with the cervical canal through a narrow neck. The main cervical canal and uterine cavity are otherwise normal. Contrast retention within the diverticulum may be seen on delayed films.
Conclusion: Hysterosalpingographic features are consistent with a cervical diverticulum.
Patient Symptoms
Many patients are asymptomatic. Symptomatic patients may present with infertility, postcoital bleeding, chronic vaginal discharge, dyspareunia, or recurrent cervicitis due to retention of secretions within the diverticulum.
Procedure (Hysterosalpingography)
The examination is performed during the early proliferative phase of the menstrual cycle. A cervical cannula or balloon catheter is inserted, and water-soluble contrast is injected slowly under fluoroscopic guidance to delineate the cervical canal, uterine cavity, and fallopian tubes.
Contrast Medium & Administration
A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is positioned in the lithotomy position. Approximately 5–8 mL of contrast is usually sufficient, injected gently to avoid false passage or extravasation.
Instruments Used
- Sterile vaginal speculum (Cusco’s or Sims’)
- Uterine tenaculum (if required)
- Leech–Wilkinson cannula
- Rubin cannula
- Balloon HSG catheter
- 10–20 mL sterile Luer-lock syringe
- Sterile connecting tubing
- Antiseptic solution
- Fluoroscopy unit
Safety Considerations
Care should be taken to avoid overfilling the diverticulum, which may cause pain or mimic extravasation. Pregnancy and active pelvic infection must be excluded prior to the procedure.
Related Conditions
Differential diagnoses include cervical fistula, cervical duplication, post-surgical sinus tract, and nabothian cyst (non-communicating). MRI or hysteroscopy can help confirm the diagnosis and guide management.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved and no identifiable information is disclosed.
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