Tubal Block (Bilateral)

Tubal Block (Bilateral) – Hysterosalpingography

Bilateral tubal block refers to obstruction of both fallopian tubes, resulting in complete absence of peritoneal spill on hysterosalpingography (HSG). The level of obstruction may be proximal (cornual or isthmic) or distal, and may be functional (tubal spasm, mucus plugging) or organic due to pelvic inflammatory disease, genital tuberculosis, endometriosis, prior surgery, or post-inflammatory fibrosis. On HSG, the uterine cavity opacifies normally, but contrast fails to traverse both tubes with no intraperitoneal spill (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing bilateral tubal block. The uterine cavity is well opacified, but both fallopian tubes fail to show distal opacification or peritoneal spill (arrows).

Findings: Normal uterine cavity outline is seen. Both fallopian tubes show non-opacification beyond the site of obstruction. No free intraperitoneal contrast spill is demonstrated on either side.

Conclusion: Hysterosalpingographic findings are consistent with bilateral tubal block.

Patient Symptoms

Patients typically present with primary or secondary infertility. Menstrual cycles are usually normal unless associated pelvic pathology is present. Bilateral tubal block represents a major cause of tubal factor infertility.

Procedure (Hysterosalpingography)

The study is performed during the early proliferative phase of the menstrual cycle. Delayed images and gentle repeat contrast injection may help exclude transient tubal spasm before labeling true bilateral tubal occlusion.

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 6–10 mL of contrast is injected slowly under fluoroscopic guidance.

Instruments Used

• Sterile vaginal speculum (Cusco’s or Sims’)
• Leech–Wilkinson cannula
• Rubin cannula
• Balloon HSG catheter
• 10–20 mL sterile Luer-lock syringe
• Sterile connecting tubing
• Antiseptic solution
• Fluoroscopy unit

Safety Considerations

High-pressure injection should be avoided to prevent tubal rupture or intravasation. Apparent bilateral block should be interpreted cautiously, especially in anxious patients where tubal spasm is common.

Related Conditions

Differential diagnoses include bilateral cornual block, bilateral isthmic block, distal tubal block, hydrosalpinx, peritubal adhesions, and genital tuberculosis. Laparoscopy remains the gold standard for confirmation.

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Declaration

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