Imaging of hydrosalpinx with torsion following tubal sterilization
Russin, L.D.
Seminars in Ultrasound Ct and Mr 9(2): 175-182
1988
ISSN/ISBN: 0887-2171 PMID: 3078665 Document Number: 356698
Tubal sterilization, most commonly by means of ligation or cauterization, is performed every year on over 500,000 women in the U.S. It is generally regarded as a safe and effective means of pregnancy prevention. It has been reported, however, that 3 of 1,000 women become pregnant with 2 years of sterilization. In a recent study, 12% of pregnancies occurring after tubal ligation and 51% of pregnancies following tubal cauterization were ectopic. After several years, surgically sterilized fallopian tubes exhibit pathologic changes. After 5 years of sterilization, 80% of patients develop dilation of the proximal stump lumen, which may be filled with blood and fragments of menstrual endometrium. 39% of patients develop fibrosis of the distal stumps after 5 years of sterilization. If the lumen becomes blocked at 2 sites, hydrosalpinx forms as a result of tubal epithelium secretions. This condition has increasingly been observed as a consequence of tubal sterilization. Since 1956, 30 cases of hydrosalpinx due to tubal ligation and cauterization have been reported. In 25 of these cases, torsion of the hydrosalpinx resulted in acute abdominal pain; in some cases, gangrene had developed. On average, 3.8 years elapsed between tubal sterilization and clinical presentation. Hydrosalpinx has been detected through both computerized tomography and ultrasound, allowing for preoperative diagnosis. It is usually imaged as a thin-walled adnexal cyst. Torsion is seen as a larger cystic structure with thicker walls. The key to diagnosis is awareness of a patient's medical history.