Tubal Fistula (HSG)

Left Tubal Fistula – Hysterosalpingography

Left tubal fistula represents an abnormal communication between the fallopian tube and an adjacent pelvic structure, allowing contrast to leak from the tubal lumen. On hysterosalpingography (HSG), features include extravasation of contrast outside the fallopian tube, irregular tubal outline, and possible distal obstruction.

Fig-1

Fig. 1—Hysterosalpingogram showing left tubal fistula. Contrast extravasation is seen outside the tubal lumen (arrows).

Findings: The affected fallopian tube may appear irregular, dilated proximally, and obstructed distally. Extravasation of contrast indicates abnormal communication with surrounding pelvic structures.

Conclusion: Hysterosalpingographic features are consistent with a left tubal fistula.

Patient Symptoms

Patients may present with infertility, chronic pelvic pain, or history of pelvic infection, surgery, or trauma. Recurrent infections or unusual discharge may also be reported.

Procedure (Hysterosalpingography)

HSG is performed during the early proliferative phase. Gentle, low-pressure contrast injection is essential to avoid worsening the fistulous tract or causing tubal rupture.

Contrast Medium & Administration

A water-soluble iodinated contrast medium such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is positioned in lithotomy and 5–8 mL of contrast is injected slowly under fluoroscopy.

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 excessive injection pressure to prevent worsening extravasation or tubal rupture. Active pelvic infection is a contraindication.

Related Conditions

Differential diagnoses include hydrosalpinx, pyosalpinx, tuberculous salpingitis, post-surgical tubal injury, or tubo-ovarian adhesions. Correlation with ultrasound, MRI, and microbiological tests is recommended.

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Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.