[Adnexal defect identified with hysterosalpingogram and laparoscopy during infertility evaluation]

To describe a previously unreported adnexal defect as a cause of an abnormal hysterosalpingogram (HSG), identified during infertility evaluation.

An abnormal hysterosalpingogram (HSG) consistent with partial left tubal obstruction or hydrosalpynx was identified during the evaluation of a 33 year-old nulligravida with no prior surgical history. At laparoscopy, the diagnosis was revised when a approximately 3x4cm regular, ovoid, physiologic aperture was noted in the central aspect of the left broad ligament in the region corresponding to the HSG defect. The lesion was explored but not repaired. Bilateral tubal patency was confirmed via indigo carmine chromopertubation.

Ovulation induction and intrauterine insemination were undertaken based on findings at surgery and careful discussion of same with the couple. The patient successfully conceived and had a normal term delivery.

While HSG abnormalities discovered during infertility assessment are not unusual, intrinsic or de novo peritoneal defects have not been described previously. Abnormal radiographic findings may be explained by this lesion in selected cases.