A Rare Case of Delayed Pulmonary Oedema due to Methemoglobinemia Following Laparoscopic Chromopertubation with Methyleneblue.

The patient is a young infertile lady with right tubal block on hysterosalpingogram was subjected for diagnostic hysterolaparoscopy.Hysterolaparoscopy findings were normal. Transcervical chromopertubation was performed using 20 -30 ml of diluted methylene blue through hysterosalpingogram cannula. Hesitant flow of dye was noted on left side after 2-3 flushing attempts. Ampullary block noted on right side with no spillage of the dye. Patient made an uneventful anaesthetic recovery. Five hours later patient developed tachypnea,hypotension and bluish colored urine was drained. She was shifted to ICU and patient eventually recovered after hemodynamic support with oxygen, steroids and inotropes. Spectrophotometric analysis showed methemoglobin levels of 26.3%. This case is reported for its rare but potentially fatal complication of pulmonary oedema following methylene blue. In this case pulmonary oedema manifested late in the postoperative period compared to other reported cases in the literature where pulmonary oedema was seen during intraoperative period.