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Semin Ultrasound CT MR. 1988 Apr;9(2):175-82.

Imaging of hydrosalpinx with torsion following tubal sterilization.

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Department of Diagnostic Imaging, Noble Hospital, Westfield, MA 01086.


Hydrosalpinx following tubal sterilization has been observed with increasing frequency. Women who have had PID or who have used IUDs might be at risk of developing this condition because they may already have occluded tubes from prior salpingitis. If a previously occluded tube is ligated or cauterized so that a second occlusion is created, hydrosalpinx may be anticipated. Often bilateral, hydrosalpinx may be present for years. Recurrent pelvic pain may signify intermittent noninfarctive torsion, but severe acute pain is a sign of torsion with impending infarction and gangrene in some patients. This condition has been detected by ultrasound and CT, enabling preoperative diagnosis. Presumably it will also be imaged by MR. Nontorsive hydrosalpinx is usually imaged as a thin-walled adnexal cyst. Torsion with infarction is seen as a larger cystic structure with thicker walls and internal debris from venous congestion and internal hemorrhage. Since 25 of 30 patients with post-tubal sterilization hydrosalpinx have presented with acute torsion, the significance of a nontorsive hydrosalpinx detected by any imaging modality should not be disregarded. Surgical removal or percutaneous puncture and drainage should be considered. Awareness of the patient's medical history is the key to diagnosis.


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.

[Indexed for MEDLINE]

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