Migration of the Essure device after bilateral partial salpingectomy at the time of caesarean section


Keywords

A 42-year-old woman, gravida 10, para 10, presented with constant central pelvic pain and dyspareunia since caesarean section and partial salpingectomy 16 months previously. She had no history of pelvic pain and had undergone Essure placement 13 years earlier with three subsequent unintended pregnancies. A bilateral partial Parkland salpingectomy was performed at an outside facility during her final delivery without attempt to remove the microinserts. There was no documentation of the rationale for retention of microinserts or partial rather than full salpingectomy. CT scan due to persistent pain 11 months postpartum identified an extraluminal microinsert adjacent to the sigmoid colon (Figure 1). She was referred to our office five months later after an abnormal location was again noted on the CT scan with the interval development of sigmoid diverticulitis adjoining the microinsert.

Figure 1CT Basin. Extraluminal location of the Essure device adjacent to the sigmoid colon.

Laparoscopic removal of retained microinserts and bilateral salpingectomy have been recommended after treatment for diverticulitis. Due to long-standing abnormal uterine bleeding, she elected to proceed with concurrent TLH. There were adhesions between the sigmoid colon and the pelvic side wall. The extraluminal microinsert was embedded in the omentum of the sigmoid colon and was extracted intact (Figure 2). The left fallopian tube was discontinuous at the level of the infundibulum with no microinsert present. An anterior transection of the right fallopian tube and ampulla level microinsert was evident with an exposed coil portion protruding from the lumen proximally and distally. Her pain and dyspareunia resolved completely with no further symptoms over the next year.
Figure 2:

Figure 2Operating field. Essure device partially embedded in the omentum of the sigmoid colon.

Essure devices located in the peritoneal cavity have been associated with pain, inflammatory response, adhesion formation and bowel obstruction [1-4]. Incomplete removal has been identified as a cause of persistent pain [5,6]. This case illustrates that transection of the fallopian tube for sterilization with microinserts in place can lead to microinsert extrusion with associated complications, including de novo pain.

Short summary

We report the case of a patient who had multiple pregnancies after bilateral insertion of Essure inserts who finally underwent sterilization by partial salpingectomy during a cesarean section. The fallopian tubes were transected without attempting to remove the microinserts. After giving birth, she developed de novo pelvic pain. CT scan identified the extraluminal location of the left microinsert adjacent to the sigmoid colon. She eventually underwent a laparoscopic hysterectomy, bilateral salpingectomy, and removal of the intact Essure coil adherent to her sigmoid omentum. Intraoperatively, it was noted that the right fallopian tube and the microinsert had been severed and that the coil protruded from the cut ends of the fallopian tube. Her pelvic pain resolved without further symptoms over the next year. To our knowledge, this case report is the first to describe the management of device migration and de novo pain after partial salpingectomy with the devices left in place.

The references

  • 1

    Belotte J, Shavell VI, Awonuga AO, Diamond MP, Berman JM, Yancy AF. Small bowel obstruction after sterilization with Essure microinsert: about a case. Fertil Sterile. 2011;96:e4-e6.

  • 2

    Mantel HT, Wijma J, Stael AP. Obstruction and perforation of the small intestine after Essure sterilization: report of a case. Contraception. 2013;87:121-123.

  • 3

    Casey J, Yunker A. Pelvic pain associated with Essure perforation. J Minimally Invasive Gynecol. 2016;23:292.

  • 4

    Moawad N, Mansuria S. Essure perforation and chronic pelvic pain. J Minimally Invasive Gynecol. 2011;18:285-286.

  • 5

    Pepin K, Einarsson J. Essure implants retained after salpingectomy and Essure removal procedure. J Minimally Invasive Gynecol. 2020;27:568-569.

  • 6

    Howard DL, Christenson PJ, Strickland JL. Use of intraoperative fluoroscopy during laparotomy to identify retained Essure microinsert fragments: about a case. J Minimally Invasive Gynecol. 2012;19:667-70.

Previous 51,392 workers change pension companies, move N190.62bn
Next GM to invest $6.5 billion in Michigan for electric vehicle production