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

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.

Combined hysteroscopy-laparoscopy approach for excision of pelvic nitinol fragment from Essure contraceptive device: Role of intraoperative fluoroscopy for uterine conservation

“…In this report, a case of minimally-invasive surgical management of Essure associated symptoms is described, resulting in substantially ameliorated chronic pain and other problems. While our patient experienced several Essure-associated symptoms which have been noted by others, including device migration [ 4 5 ] and implant fragmentation [ 6 ], the surgical approach used here to remove the pelvic coil is uncommon. Indeed, this is the first reported case of laparoscopic retrieval of pelvic coil fragments under fluoroscopic guidance remote from the time of initial hysteroscopic sterilization.…”

Bilateral Essure Perforation into the Abdominal Cavity

“…Tubal perforation and/or migration are rare adverse events after Essure placement. The reported incidence of perforation has been between 0.9 -2.6% [1][2][3], although these numbers may be underreported especially if patients are asymptomatic or lost to follow-up [4]. Most cases in the literature involve unilateral migration.…”

Essure Surgical Removal and Subsequent Resolution of Chronic Pelvic Pain: A Case Report and Review of the Literature

“…The reported complications associated with the device include heavy periods, irregular menses, dyspareunia, and spotting with ovulation [ 16 , 17 ]. Other rare complications include tubal or uterine perforation, intraperitoneal migration and unintended pregnancies [ 10 ], device expulsion, and infection. One study claims that the incidence of chronic pelvic pain requiring opiates for relief following hysteroscopic sterilization versus laparoscopic sterilization is increased by eight percent [ 18 ].…”

“…A small percentage of women subsequently choose to have the tubal inserts removed due to regret or perceived side effects [ 3 ]. Complications associated with the Essure device include improper placement (malpositioning), unintended pregnancy [ 10 ], chronic pelvic pain, infection, and nickel allergy [ 6 ]. There is limited information with regard to the improvement in the symptom profile following surgical removal of the tubal inserts [ 3 ].…”