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Bicontrast gynecography
Last reviewed: 07.07.2025
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Bicontrast gynecography is a combination of hysterosalpingography and pneumogynecography.
Indications: determination of the contours of the uterine cavity and lumen of the tubes, external boundaries of the internal genital organs (in case of infertility to exclude tubal factor or sclerocystic ovaries), tumors of the uterus, tubes, ovaries, developmental anomalies of the internal genital organs.
Contraindications: history of laparotomy, 3-4 degree obesity, heart and lung diseases with circulatory disorders in the small and large circles.
The method of bicontrast gynecography includes the following stages:
- preparation of the patient,
- creation of pneumoperitoneum,
- introduction of a radiopaque substance into the uterine cavity;
- conducting bicontrast X-ray pelviography.
It is performed in the 2nd phase of the menstrual cycle. Carbon dioxide, oxygen or nitrous oxide are used. The patient is placed in the Trendelenburg position. In order to obtain a clear X-ray picture of the uterus and ovaries, the patient must be carefully prepared. For this purpose, for three days before the examination, the intake of food containing carbohydrates and fiber is limited (to reduce gas formation), activated carbon is prescribed 2 tablets 3 times a day. A cleansing enema is given in the evening before the examination and in the morning.
The amount of gas introduced should not be less than 2000 ml, and in large women with increased body weight - 3000 ml. The shadows of the genitals on radiographs exceed their true size by 15-20%.
Abroad and in our republic, in clinical institutions where echoscopic examination and laparoscopy are widely used, this method is rarely used.
X-ray examination of the adrenal glands under retropneumoperitoneum conditions. It is rarely used in gynecological clinics. As a rule, this examination is performed in endocrinology or urology departments of multidisciplinary hospitals when there is a suspicion of adrenal neoplasm or hyperplasia, which is usually accompanied by a clinical picture of virilization. The examination is preceded by the same preparation as before pneumopelviography.
The gas enters the presacral area through a needle inserted between the coccyx and rectum, with the patient in a knee-elbow position. The needle is directed strictly along the midline between the anus and coccyx. The amount of gas injected is 2000-3000 ml. The gas spreads through the loose tissue to the perirenal area. Slow walking for 30 minutes after its introduction helps to distribute the gas evenly. X-ray or tomographic examinations are performed within 2-3 hours after the gas is injected.
Contraindications: inflammatory processes in the pararectal tissue, hemorrhoids, cardiopulmonary insufficiency.
Normally, the adrenal glands on the radiograph have a triangular shape, located above the upper poles of the kidneys. In hyperplasia, enlarged adrenal glands are visible. In case of a tumor, the adrenal gland is enlarged on the affected side; the size of normal, non-enlarged adrenal glands on the tomogram varies in length and width from 1 to 4 cm.
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