Loculated Peritoneal Spill – Hysterosalpingography
HSG
Loculated spill indicates partial peritoneal contrast dispersion due to adhesions or peritubal scarring. On hysterosalpingography (HSG), contrast escapes the fallopian tube(s) but remains confined to localized pockets rather than spreading freely throughout the peritoneal cavity.
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Findings: Uterine cavity may appear normal. Fallopian tubes opacify but contrast does not disperse freely due to peritubal adhesions or focal pelvic adhesions, often unilateral or bilateral.
Conclusion: HSG findings are consistent with loculated peritoneal spill secondary to adhesions.
Patient Symptoms
Patients may present with infertility, chronic pelvic pain, history of pelvic infection, or prior pelvic surgery.
Procedure (Hysterosalpingography)
HSG is performed during the early proliferative phase. Gentle, low-pressure contrast injection is essential to avoid causing tubal rupture or worsening adhesions.
Contrast Medium & Administration
A water-soluble iodinated contrast medium such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. Patient is positioned in lithotomy and 5–8 mL of contrast is slowly injected 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 rupture. Active pelvic infection is a contraindication.
Related Conditions
Loculated spill differentiates peritubal adhesions or pelvic adhesions from normal or free peritoneal spill. Correlation with clinical history, ultrasound, and laparoscopy may help assess the extent of adhesions.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.
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