Septate Uterus with Hydrosalpinx (HSG)

Septate Uterus with Hydrosalpinx (Hysterosalpingography)

Septate uterus with hydrosalpinx represents a combined Müllerian duct anomaly and tubal pathology contributing to infertility. The septate uterus results from incomplete resorption of the uterovaginal septum, while hydrosalpinx is caused by distal tubal obstruction leading to dilatation of the fallopian tube. On hysterosalpingography, a midline septum divides the uterine cavity, and the affected fallopian tube shows dilatation with delayed or absent peritoneal spill of contrast (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing a septate uterus with hydrosalpinx. A persistent midline septum divides the uterine cavity into two hemicavities. One fallopian tube is markedly dilated and tortuous with contrast retention and no free intraperitoneal spill, consistent with hydrosalpinx (arrows).

Findings: The uterine cavity is divided by a smooth central septum. The affected fallopian tube demonstrates fusiform dilatation with clubbed distal end and delayed drainage of contrast. No free peritoneal spill is seen from the involved tube.

Conclusion: Hysterosalpingographic findings are consistent with a septate uterus associated with hydrosalpinx.

Patient Symptoms

Patients typically present with primary or secondary infertility. Some may report chronic pelvic pain, history of pelvic inflammatory disease, or prior pelvic surgery. Recurrent implantation failure may be noted in assisted reproductive therapy cases.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. After aseptic preparation, a cervical cannula or balloon catheter is placed. Water-soluble contrast is injected slowly under fluoroscopic guidance to assess uterine morphology and tubal patency.

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. A total volume of 8–14 mL is administered gradually. Forceful injection is avoided in suspected hydrosalpinx.

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 inject contrast slowly to reduce the risk of tubal rupture and intravasation. Pregnancy and active pelvic infection must be excluded. Prophylactic antibiotics may be considered in patients with hydrosalpinx or prior pelvic infection.

Related Conditions

Differential diagnoses include septate uterus with tubal block, pelvic inflammatory disease, post-surgical tubal scarring, and bicornuate uterus with associated tubal pathology. MRI or 3D ultrasound can help confirm uterine morphology.

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Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been maintained and no identifiable data is disclosed.