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Cornual and interstitial occlusion means the the tubes are blocked at the end near the uterus.  This can occur because of infection, endometriosis, dried secretions in the tube, mucus in the tube or scar.  In an infection is active, antibiotics can open the tubes.  Their is also an association of endometriosis with cornual occlusion.  Hormonal suppression can help some women.  A protocol for therapy is at Current Clinical Protocol.

This may also be due to spasm as a reaction to X-ray dye or to inadequate pressure.  These may  be corrected by medicine to relieve the spasm and/or by repeat hysterosalpingogram.

Salpingitis isthmica nodosa (SIN) is the term for nodular scarring of the tubes.  Salpingitis means this is inflammation of the salpinx (tube).  Isthmica is the word for the anatomic area near the top of the uterus.  Nodosa means the nodular appearance.  In very early stages, the tubes may appear almost normal.  As scarring and nodularity progress, the changes become more apparent.

Severe SIN can have large nodules trapping old blood.  This looks like and can be confused with endometriosis of the tubes.   The exact nature (SIN, endometriosis or other nodular scarring) is determined by removing the scarred area and sending it for microscopic analysis.  This example demonstrates severe damage.

A hysterosalpingogram (HSG) X-ray of the nodular area with severe SIN shows several pockets containing the X-ray dye.  Of specific note is the observation that no dominant channel is seen as the dye flows through the tube.  This means there appears to be no direct pathway for sperm to travel.  This increases the chance of a tubal pregnancy.

This can be contrasted with a normal HSG.

Although some forms of cornual occlusion respond to antibiotics or hormonal suppression, SIN often requires removal due to pain or the increased chance of tubal pregnancy.  Tubal pregnancies (ectopic pregnancy) are increased due to the internal scar in the tubal canal that transports the egg to the uterus.  IVF is usually a better answer that tubal reconstruction.

Pseudo-Occlusion or Inadequate Filling

Pseudo-occlusion or inadequate filling can produce a confusing picture that makes the tubes look scarred or absent.  But, the tubes are not seen due to spasm, infection, inadequate pressure, mucus in the tube and other causes

Clinical Management

A clinical management protocol is on the pdf  "Therapeutic Implications of Diagnostic Hysteroscopy for Cornual Occlusion."

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