Collaborative Research Article Published in Hospital Practices and Research
Thomas A. Paterniti1, Lee Weber1, Gene Krishingner2,Sarfraz Ahmad1,3
1College of Medicine, Florida State University, Orlando, FL 328012Women’s and Maternity Care Specialists, Winter Park, FL 327923Department of Gynecologic Oncology,
Florida Hospital (AdventHealth) Cancer Institute, Orlando, FL 32804
Essure® device malposition is a rare, but clinically significant complication, for which management is idiosyncratic. This case report describes an unusual example of Essure® migration in order to clarify reasonable management options. A 50-year old G4P2022 underwent hysteroscopic sterilization using the Essure® device. Insertion was complicated by fragmentation of both coils. Two years later, one of the coils was incidentally discovered protruding through the cervical os. The visible portion was clipped when attempts to remove the entire coil were unsuccessful. Difficult placement increases the risk of Essure® malposition. In asymptomatic patients, conservative management with removal of only a portion of the device is a rational approach.
Careful examination of hysteroscopic sterilization device micro-inserts should be performed in patients with chronic pelvic pain, especially in the context of a difficult device placement, whether due to device fragmentation, poor visibility or challenging anatomy. Hysteroscopic examination for symptomatic patients should focus on ensuring that no migration or fragmentation of the device has occurred. Asymptomatic migration into the endometrial cavity may reasonably be treated by clipping the protruding portion of the device, while migration into the cervical os represents an extremely rare and challenging situation in which a careful discussion of the risks and benefits with the patient is warranted. In this scenario, we chose to trim the asymptomatic coil close to the cervical os and leave the remaining fragment in place rather than risking the trauma of further operation.
For more information or to refer a patient, call GYN Oncology Care Coordinator Denise Cochran, MSN, ARNP, BC, at Call407-303-5909.