Methylene Blue induced bluish discoloration mimicking cyanosis, at diagnostic laparoscopy

Abstract

BACKGROUND: Methylene blue is commonly used to check patency of Fallopian tubes and tracking fistulae. Intraversation of methylene blue is a recognized complication of diagnostic laparoscopy and dye test. Although a case of cyanosis due to methaemoglobinaemia following methylene blue use is a known complication, cyanosis without methaemoglobinaemia is unknown. CASE PRESENTATION: A 31 year old healthy female, being investigated for primary subfertility for 3 years underwent a diagnostic laparoscopy for evaluation of her fallopian tubes under general anaesthesia. Methylene blue 20 ml was injected to see the patency of the tubes. The patient became centrally cyanosed soon after dye ingestion. Her oxygen saturation dropped to 10% whilst her partial pressure of oxygen remained normal. CONCLUSION: Bluish discoloration of the body can occur in the absence of methaemoglobinaemia in patients undergoing laparoscopy following dye ingestion for evaluation of fallopian tubes using methylene blue. Recognizing this complication will help in avoiding unnecessary intervention to the patient. CASE PRESENTATION: A 31 year old healthy female, being investigated for primary subfertility for 3 years underwent a diagnostic laparoscopy for evaluation of her fallopian tubes under general anaesthesia. Methylene blue 20 ml was injected to see the patency of the tubes. The patient became centrally cyanosed soon after dye ingestion. Her oxygen saturation dropped to 10% whilst her partial pressure of oxygen remained normal.