Case Report: Intravasation of water-soluble contrast agent into the internal iliac vein during hysterosaplingography

Author : Tasnim Hussain

Abstract :Background • Rare complications of Hysterosalpingography are infection, embolic phenomenon, vaso-vagal attack, uterine perforation, granuloma formation, pelvic peritonitis and dye intravasation. • Iobitriol, is water-based contrast medium that is less toxic and more soluble then previously used agents. Case Presentation • 32 years old Saudi lady with 7 years primary subfertility presented at REI Department, Women’s Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia. • She had irregular cycle, PCO and a BMI of 36.6. Her husband was 33 year old healthy man with normal semen analysis. • HSG was done in the follicular phase. Catheter placement in the cavity was confirmed by fluoroscopic image. After taking initial image of pelvis, Iobitridol contrast was injected slowly through the catheter. • When 5ml of contrast was injected, patient complained of sudden and severe lower abdominal pain. Procedure was stopped and the radiologist informed that contrast is seen entering the parametrial vessels and internal iliac vein. • Patient was immediately shifted to the emergency room. She was in pain, but hemodynamically stable. There were no symptoms/signs of hypersensitivity or any system involvement. • She was given analgesia and IV fluids. Her blood count, liver, kidney function tests, blood sugar and electrolytes were normal. • Patient was discharged after six hours of observation. • X-ray films were re-reviewed by radiologists. Intravasation of contrast was noted in the venous plexus of myometrium and was seen draining into internal iliac veins.

Keywords :Hysterosalpingography, contrast intravasation, Iobitridol, subfertility, PCO, parametrial vessels, pelvic pain, venous plexus, REI, King Fahad Medical City.

Conference Name :International Conference on Reducing Maternal and Child Mortality and Morbidity (ICRMCMM-25)

Conference Place Raozan Upazila, Raozan Upazila

Conference Date 10th Jun 2025