Tubal Occlusion – Hysterosalpingography
HSG
Tubal occlusion refers to a complete blockage of one or both fallopian tubes. On hysterosalpingography (HSG), contrast opacifies the proximal portion of the tube(s) but terminates abruptly at the site of obstruction with no peritoneal spill.
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Findings: Uterine cavity may appear normal. Proximal tubal segments are opacified, while distal segments are not visualized. Absence of free intraperitoneal contrast confirms complete obstruction.
Conclusion: HSG findings are consistent with tubal occlusion.
Patient Symptoms
Patients often present with infertility, history of pelvic inflammatory disease, prior pelvic surgery, or tubal ligation. Chronic pelvic pain may also be present.
Procedure (Hysterosalpingography)
HSG is performed during the early proliferative phase. Gentle contrast injection is essential to avoid tubal rupture or patient discomfort.
Contrast Medium & Administration
A water-soluble iodinated contrast medium 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 excessive injection pressure. Active pelvic infection is a contraindication. Proper patient counseling is recommended.
Related Conditions
Tubal occlusion may be unilateral or bilateral, proximal or distal, and may result from infection, tuberculous salpingitis, post-surgical adhesions, or congenital anomalies. Correlation with clinical history and imaging is advised.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.
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