Essure Microinsert Abdominal Migration after Hysteroscopic Tubal Sterilization of an Appropriately Placed Essure Device: Dual Case Reports and Review of the Literature.

Shadi Rezai,Dilfuza Nuritdinova,Hunter Azdel Gomez Roberts,Malvina Elmadjian,Cassandra E Henderson,Isamarie Lora Alcantara,Meghan Labine

doi:10.1155/2015/402197

Shadi Rezai, Dilfuza Nuritdinova + Show 5 more

Open Access

https://doi.org/10.1155/2015/402197

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Abstract

Background. The Essure device is a method of permanent sterilization widely used in the US that has proven to be safe and effective in most cases. However, there have been reports of device migration that have led to failed tubal occlusion as well as several other serious complications resulting from the presence of the device in the abdominal cavity. Case. This paper represents two cases of failed tubal occlusion by an appropriately placed Essure device without signs or symptoms of further complications related to device migration. Conclusion. Although there have only been 13 reported cases of abdominal device migration since November 2014, this case indicates that the actual number may be higher than reported since it is possible for migration to occur without additional complications. In the majority of reported cases of abdominal migration a major complication requiring surgical correction occurred, such as adhesions, small bowel obstruction, bowel perforation, or persistent pelvic pain. To avoid these complications it is recommended that migrating implants be removed; however, this case also represents an example of when a migrating device may remain in situ in an asymptomatic patient.

Highlights

The Essure device is a method of permanent sterilization widely used in the US that has proven to be safe and effective in most cases
This report, documents a case of failure of tubal occlusion of a previously appropriately placed Essure device [1] due to Essure microinsert abdominal migration that did not result in major complications requiring surgical intervention [3]
The first patient in this case, declined laparoscopic removal of the Essure device. This was observed to be a safe option by Kerin et al [3, 15] who reported three cases of migrating Essure devices that were left in situ after noting that the pelvic organs were healthy and normal

Summary

Background

The Essure pbc (Permanent Birth Control System) device is a dynamic expanding microinsert that stimulates benign tissue growth when placed in the proximal section of the fallopian tube, eventually occluding the tube. Of the approximately 50,000 Essure insertion procedures performed between 1997 and 2005, there were 64 reports of unintended pregnancies to the manufacturer, most of which were attributed to failure to use alternative birth control methods prior to confirmation that the device had expanded to fully occlude the fallopian tubes [11]. This report, documents a case of failure of tubal occlusion of a previously appropriately placed Essure device [1] due to Essure microinsert abdominal migration that did not result in major complications requiring surgical intervention [3]. The patient was asymptomatic prior to pregnancy, indicating that there may be more unreported cases of device migration These risks and complications should be taken into account when considering Essure as a method of sterilization

Presentation of Case Number 1

Presentation of Case Number 2

Discussions

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Conclusion