Uterine Fistula – Hysterosalpingography
HSG
A uterine fistula is an abnormal communication between the uterine cavity and an adjacent organ, such as the bladder, bowel, or vagina. On hysterosalpingography (HSG), contrast may leak from the uterine cavity into the connected organ, providing direct visualization of the fistulous tract.
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Findings: Uterine cavity may appear irregular or normal. Contrast passes through a tract connecting the uterus to the bladder, bowel, or vagina, confirming a fistulous communication.
Conclusion: HSG findings are consistent with a uterine fistula.
Patient Symptoms
Patients may present with abnormal vaginal or urinary discharge, recurrent infections, infertility, or history of pelvic surgery, trauma, or radiation therapy.
Procedure (Hysterosalpingography)
HSG is performed during the early proliferative phase. Careful, low-pressure contrast injection is essential to avoid enlarging the fistulous tract or causing discomfort.
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 under fluoroscopic guidance in the lithotomy position.
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 should be treated before the procedure. Proper patient counseling is recommended.
Related Conditions
Uterine fistulas may occur after surgery, radiation, trauma, infection, or congenital anomalies. Differential diagnosis includes vesico-uterine, recto-uterine, or vesico-vaginal fistulas. Correlation with clinical history, ultrasound, CT, or MRI may be required.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.
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