Nigel Pereira, MD, Irene Grias, DO, Carl R. Della Badia, DO
Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA (Dr. Pereira). Division of Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA (Drs. Grias, Della Badia).
Introduction: Perforation of the uterus or fallopian tube during microinsert placement, with subsequent migration of the microinsert into the abdominopelvic cavity, is a known complication.
Case Description: A 38-year-old woman underwent hysteroscopic tubal sterilization with Essure microinserts (Conceptus, Mountain View, California). She returned 4 months later for hysterosalpingography, during which only part of the right microinsert was identified in the right cornu of the uterus. The remaining part of the microinsert was suspected to be in the pelvic cavity. Laparoscopy showed one fragment of the right microinsert projecting from the right cornu; the remaining fragment was incorporated into the serosa of the distal ileum. After an intraoperative consultation with the colorectal surgery team, both fragments of the microinsert were left as is, and tubal fulguration for sterilization was performed.
Discussion: Although perforated microinserts can cause small-bowel obstruction or perforation, our case highlights the asymptomatic incorporation of a microinsert into the serosa of the distal ileum.
Key Words: Essure, Hysteroscopy, Complications, Small bowel, Migration.