International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - vol 05 issue 19, October, 2013

Pages: 66-68

Date of Publication: 19-Oct-2013

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Author: K. Natarajan, N. Murugesan

Category: Healthcare

Abstract:Methylene blue is used as a diagnostic and therapeutic agent in humans. Adverse reaction to the dye is very rare. But when adverse reaction occurs it can be very severe and dangerous. The reaction may be local or generalized and sometimes life threatening and can be even fatal. This should be kept in mind to avoid or minimize the severe reactions to the dye. We hereby present a female patient who developed severe chemical peritonitis with small bowel perforations to the methylene blue dye in the course of investigation for primary infertility.

Keywords: Methylene blue, Chemical peritonitis, Ileal perforation

Full Text:


Methylene blue is a versatile dye which is used in a variety of situations from diagnosis to therapy, across all branches of medicine. It is used in the investigations of sinuses, fistula, sentinel node localization in malignancy, normal and abnormal tissue identification (tattooing of colonic mucosa during colonoscopy) and patency of Fallopian tubes. Gynecologists routinely use methylene blue dye solution to test the patency of Fallopian tubes in the course of investigations for infertility. Reactions to the dye are very rare. But when it occurs it can be very serious and can lead to major complications like chemical peritonitis1,2,3, general skin reactions, tissue necrosis4,5, methemogobinemia6,7, anaphylaxis8, pulmonary edema09,10 etc.


A 30 year old patient underwent diagnostic laparoscopy and tube patency test using 0.5% sterile methylene blue dye solution. The whole procedure was uneventful. She recovered from the anaesthesia completely and started taking oral fluids after 6 hours. She developed lower abdominal pain after 24 hours which was constant and not associated with any vomiting. On examination she had mild diffuse tenderness in the lower abdomen with no rebound tenderness. Bowel sounds were present. She was started on IV fluids and antibiotics and kept nil oral. She continued to have abdominal pain and on the fourth day developed severe abdominal pain with signs of peritonitis. Immediately she underwent emergency laparotomy. At laparotomy the peritoneal cavity was found to have turbid fluid. The terminal ileum was stained in many parts with methylene blue and there were four perforations in the areas of blue staining. The terminal part of the ileum was thickened, white and found not viable. The terminal ileum with the perforations was resected and end to end anastomosis was done. She recovered slowly and was started on oral fluids after flatus was passed.  She developed a small bowel fistula in the lower part of the abdominal wound on the 20th day. She was treated conservatively with NPO and IV fluids. Ultra sound examination of the abdomen did not show 

any intra peritoneal collection or any other abnormality. The fistula closed spontaneously within a week. She was discharged home afterwards. Histopathological examination of the resected bowel showed severe diffuse inflammation of the small bowel with multiple perforations.

In the course of the next 6 months she had intermittent discharge of small bowel contents from the same area of previous small bowel fistula. Each time it closed spontaneously.

She underwent Ultrasound examination of the abdomen which did not reveal any abnormality. CT Abdomen also was normal.  Fistulogram showed filling of the small bowel with the contrast. Large bowel was not filled with the contrast.

After these investigations she underwent an elective Laparotomy under GA. At laparotomy stricture of the terminal ileum beyond the fistulous opening was found. That part was resected and ileo caecal anastomosis was performed. The post operative period was uneventful.


Literature is very limited due to the rarity of the adverse reaction to the dye and only a few references are available. Various types of reaction to methylene blue dye like anaphylaxis8,  methemoglobinemia6,7, pulmonary oedema09,10, chemical peritonitis1,2,3 or local skin reactions4,5  have been described. The patient in this report developed severe chemical peritonitis with multiple perforations of the small bowel. Formation of intraperitoneal adhesions in rats is reported in experimental studies11. To prevent adverse reactions to the dye, O’Sullivan advises the use of very dilute solution of the dye(1 ml of 1% methylene blue dye diluted in 100 ml of sterile saline). Aspiration of the dye from the peritoneal cavity and steroid wash to the areas of contact with the dye after completing the procedure might also help.


Adverse reaction to methylene blue dye is very rare. The reaction may be local at the site of application or general. The physician using the dye must take appropriate preventive steps like using very dilute solution, aspirating the dye after usage and giving steroid lavage. When adverse reaction occurs this should be treated promptly. The adverse reactions, the preventive measures and treatment are to be kept in mind whenever this dye is used.


  1. Nolan DG. Inflammatory peritonitis with ascites after methylene blue dye

chromopertubation during diagnostic laparoscopy. J Am Assoc Gynecol

Laparosc 1995; 2: 483–485.

  1. Macia M, Gallego E, Garcia-Cobaleda I et al. Methylene blue as a cause of chemical peritonitis in a patient on peritoneal dialysis. Clin Nephrol 1995; 43: 136–137
  2. O’Sullivan JC. Female sterility produced by investigation, Br. Med. J.; Vol 4 ISS Nov. 24,1973, P490
  3. M Salhab, W Al sarakbi and K Mokbel Skin and fat necrosis of the breast following methylene blue dye injection for sentinel node biopsy in a patient with breast cancer International Seminars in Surgical Oncology 2005, 2:26 doi:10.1186/1477-7800-2-26
  4. Stradling B, Aranha G, Gabram S.  Adverse skin lesions after methylene blue injections for sentinel  node localization. Am J Surg. 2002 Oct; 184(4):350-2
  5. Mhaskar R, Mhaskar AM Methemoglobinemia following chromopertubation in treated pelvic tuberculosis. Int J Gynaecol Obstet. 2002 Apr;77(1):41-2. PMID:11929658 [PubMed - indexed for MEDLINE]
  6. Bilgin H, Ozcan B, Bilgin T. Methemoglobinemia induced by methylene blue pertubation during laparoscopy.Acta Anaesthesiol Scand. 1998 May;42(5):594-5.PMID:9605379 [PubMed - indexed for MEDLINE]
  7. Rzymski P, Wozniak J, Opala T, Wilczak M, Sajdak S. Anaphylactic reaction to methylene blue dye after laparoscopic chromopertubation. Int J Gynaecol Obstet. 2003 Apr; 81(1):71-2.
  8. Teknos D, Ramcharan A, Oluwole SF Pulmonary edema associated with methylene blue dye administration during sentinel lymph node biopsy..J Natl Med Assoc. 2008 Dec;100(12):1483-4.PMID:19110921 [PubMed - indexed for MEDLINE]
  9. Millo T, Misra R, Girdhar S, Rautji R, Lalwani S, Dogra TD. Fatal pulmonary oedema following laparoscopic chromopertubation. Natl Med J India. 2006 Mar-Apr;19(2):78-9. PMID: 16756195 [PubMed - indexed for Medline]
  10. Gul A, Kotan C, Dilek I, Gul T, Tas A, Berktas M, Effects of methylene blue, indigo carmine solution and autologous erythrocyte suspension on formation of adhesions after injection into rats. Reprod Fertil. 2000 Nov;120(2):225-9

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Best Article Award

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
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A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19

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