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Unsuspected cyesis at hysterosalpingogram with resultant disruption of pregnancy – a case report

Osesogie Usuale Ogbeide

Am J Case Rep 2008; 9:404-407

ID: 869420

Background: Hysterosalpingogram is a common radiological examination in the investigation of infertility and sub-fertility in women. The main aim of the examination is to assess the size of the uterine capacity and patency of fallopian tubes, which is demonstrated as free intra-peritoneal spillage of contrast.
Common results of an examination include irregularity of the uterine outline, non-opacification or dilatation of the fallopian tubes, loculated intra-peritoneal spillage of contrast.
Case Report: The case of a 29-year-old nulliparous woman with a diagnosis of primary infertility and booked for hysterosalpingogram as part of the routine work-up is presented. Based on the menstrual history and a negative urinary pregnancy test on the morning of the procedure, the examination was carried out. However, the result showed evidence of intra-uterine cyesis which was confirmed on pelvic ultrasonography. The examination is routinely carried out when the patient is not pregnant, and all available investigations are carried out to prevent irradiation of the unborn fetus. Inadvertent irradiation of an intra-uterine fetus is a rare occurrence and the complications will include abortion as seen in this case report.
Conclusions: Caution must be taken when performing a hysterosalpingogram to prevent the inadvertent exposure of a pregnant uterus. The reliance on the menstrual history and a negative pregnancy test and denial of the sexual intercourse prior to the examination did not help in this case report. The resultant complication is the spontaneous abortion of a precious baby that the couple has been seeking for and for which the procedure was performed.

Keywords: hysterosalpingogram , intra-uterine pregnancy , abortion, Infertility

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