Journal of Case Reports and Images in Obstetrics and Gynecology | 2021

Spontaneous anterior abdominal wall expulsion of female sterilization Filshie clips

 
 
 

Abstract


Introduction: Filshie clip ligation is a common procedure for female sterilization. Rarely, Filshie clips may dislodge and migrate through tissue planes (0.6%) involving bladder, appendix, inguinal canal, vagina, urethra, and rectum. The pathophysiology is unclear. We discuss a case of delayed Filshie clip expulsion from the anterior abdominal wall. Case Report: A 35-year-old Chinese lady presented with a few-month history of a 6 × 5 cm superficial, firm, tender, and mobile infra-umbilical lump with purulent discharge and surrounding erythema. She was afebrile and her inflammatory markers were not raised. Obstetrical history included three lower segment caesarean sections via Pfannenstiel incision, and Filshie clip postpartum sterilization three years ago. She denied other medical or surgical history. Computerized tomography showed a 2.1 cm hyper-dense soft tissue in the infra-umbilical anterior abdominal wall containing two ligation clips. She opted for conservative management with antibiotics. The clips expelled spontaneously from the abdominal lump in succession over the next month—both were closed and complete. Subsequent hysterosalpingography showed Hui Men Selina Chin1, Song He2, Shau Khng Lim3 Affiliations: 1BA, MA, MBBS, Medical Officer, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore; 2MD, MRCOG, Registrar, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore; 3MBBS, MMed, MRCOG, FAMS, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore. Corresponding Author: Hui Men Selina Chin, Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Road, 169608, Singapore; Email: selina.chin@mohh. com.sg Received: 07 June 2021 Accepted: 11 July 2021 Published: 13 August 2021 abrupt truncation in bilateral fallopian tubes with no peritoneal spillage. Conclusion: Spontaneous anterior abdominal wall expulsion of Filshie clips is a rare complication of tubal ligation that may occur from weeks to years after. When patients are counseled pre-operatively, risks of clip migration and expulsion should be discussed. Sterilization history should also be sought in females presenting with abdominal pain.

Volume None
Pages None
DOI 10.5348/100090z08hc2021cr
Language English
Journal Journal of Case Reports and Images in Obstetrics and Gynecology

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