Delayed Peritoneal Spill – Hysterosalpingography
HSG
Delayed spill indicates partial or slow passage of contrast into the peritoneal cavity. On hysterosalpingography (HSG), the fallopian tubes opacify completely, but free peritoneal spill occurs only after a delay, suggesting transient obstruction or partial distal tubal narrowing.
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Findings: Uterine cavity is normal. Tubes demonstrate smooth outlines, and delayed peritoneal spill suggests partial distal obstruction, mild peritubal adhesions, or transient tubal spasm.
Conclusion: HSG findings are consistent with delayed peritoneal spill, indicating partial tubal patency.
Patient Symptoms
Patients may present with infertility or history of mild pelvic inflammatory disease. Symptoms are often subtle in cases of transient obstruction.
Procedure (Hysterosalpingography)
HSG is performed during the early proliferative phase. Gentle injection is recommended to avoid tubal spasm or false-positive obstruction.
Contrast Medium & Administration
A water-soluble iodinated contrast medium such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. 5–8 mL is injected slowly in the lithotomy position 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
Avoid high injection pressure to prevent tubal spasm or rupture. Active pelvic infection is a contraindication.
Related Conditions
Delayed spill helps differentiate partial distal obstruction or mild peritubal adhesions from complete tubal blockage. Clinical correlation and follow-up imaging may be required.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.
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