Green urine sign after laparoscopic chromopertubation as an effect of severe contrast intravasation: a report of three cases

Abstract

Tubal diseases are responsible for 25% to 35% of female infertility. Laparoscopic chromopertubation is the gold standard for assessing tubal patency when female infertility is suspected. Intravasation is a complication of intrauterine procedures involving the passage of fluid filling the uterine cavity into the bloodstream through endometrial vessels (from the myometrial veins to the uterine venous plexuses). This complication has been described during hysterosalpingography and sonohysterosalpingography. We herein present a report of three cases in which severe intravasation occurred during laparoscopic chromopertubation using methylene blue as a contrast agent. The intravasation manifested as green urine (i.e., the “green urine sign”). The presence of methylene blue in the urine and blood was confirmed by laboratory tests. All three patients had risk factors for intravasation as described in the literature (unilateral or bilateral tubal obstruction, endometriosis, and previous intrauterine procedures for Mullerian duct anomalies and Asherman’s syndrome). The green urine sign appeared a few hours after laparoscopic chromopertubation and spontaneously resolved after 24 hours. Cystoscopy was performed to rule out bladder injury. All three patients required only clinical observation.

A child with green urine after a diagnostic enema: Answers

“…While the peak of excretion is between 2 and 6 h after administration, it can be detected in urine through chromatographic techniques until 24-48 h after administration. Methylene blue-related greenish urine discoloration has been reported after several modes of administration of the dye: these include both direct intravenous infusion [11] and systemic absorption after oral administration [14,15], uterine filling during laparoscopic chromopertubation for infertility work-up [16], colon submucosal injections [17], irrigation of the bowel lumen [18], and manipulation of the paralytic ileum [19]. To date, only one case of urine discoloration after a methylene blue enema has been described in adults [20], and no similar reports exist in the pediatric literature.…”