No Peritoneal Spill – Hysterosalpingography
HSG
No spill indicates complete distal tubal obstruction. On hysterosalpingography (HSG), contrast opacifies the fallopian tube(s) but fails to enter the peritoneal cavity, suggesting blockage at the fimbrial end or along the distal tubal segment.
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Findings: Uterine cavity may be normal or mildly dilated. Tubes may appear dilated proximally if obstruction is chronic, and distal tubal occlusion is confirmed by absence of free spill.
Conclusion: HSG findings are consistent with complete tubal obstruction.
Patient Symptoms
Patients often present with infertility or history of pelvic inflammatory disease, tubal surgery, or previous infection. Symptoms may include pelvic pain or recurrent infections.
Procedure (Hysterosalpingography)
HSG is performed during the early proliferative phase. Gentle, low-pressure contrast injection is essential to prevent tubal rupture.
Contrast Medium & Administration
Water-soluble iodinated contrast such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. Approximately 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 rupture. Active pelvic infection is a contraindication.
Related Conditions
No spill is seen in complete distal tubal obstruction, hydrosalpinx with fimbrial blockage, or post-surgical ligation. Correlation with clinical history, ultrasound, and laparoscopy is recommended.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.
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