A kink is not always a perforation: assessing Essure hysteroscopic sterilization placement
2011
Borley, Jane | Shabajee, Natasha | Tan, Toh Lick
OBJECTIVE: To highlight the fallacy of using a kink in the microinsert outline on plain abdominal x-ray as a marker for tubal perforation. DESIGN: Case report. SETTING: West London District general hospital. PATIENT(S): 36-year-old Asian woman requesting permanent sterilization. INTERVENTION(S): Essure hysteroscopic sterilization followed by abdominal x-ray, pelvic ultrasound, and laparoscopy. MAIN OUTCOME MEASURE(S): Absence of tubal perforation. RESULT(S): A patient presented with clinically suspected fallopian tube perforation 3 days after Essure hysteroscopic sterilization. Her transvaginal scan was inconclusive, but the plain x-ray demonstrated a kink within the left microinsert outline. Diagnostic laparoscopy did not identify a perforation, and bilateral tubal placement was confirmed after salpingectomy. CONCLUSION(S): This case highlights the difficulty of relying on imaging in the acute setting to establish a diagnosis of tubal perforation after hysteroscopic sterilization.
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