A kink is not always a perforation: assessing Essure hysteroscopic sterilization placement.

OBJECTIVE

To highlight the fallacy of using a kink in the microinsert outline on plain abdominal x-ray as a marker for tubal perforation.

DESIGN

Case report.

SETTING

West London District general hospital.

PATIENT(S): 36-year-old Asian woman requesting permanent sterilization.

INTERVENTION(S): Essure hysteroscopic sterilization followed by abdominal x-ray, pelvic ultrasound, and laparoscopy.

MAIN OUTCOME MEASURE(S): Absence of tubal perforation.

RESULT(S): A patient presented with clinically suspected fallopian tube perforation 3 days after Essure hysteroscopic sterilization. Her transvaginal scan was inconclusive, but the plain x-ray demonstrated a kink within the left microinsert outline. Diagnostic laparoscopy did not identify a perforation, and bilateral tubal placement was confirmed after salpingectomy.

CONCLUSION(S): This case highlights the difficulty of relying on imaging in the acute setting to establish a diagnosis of tubal perforation after hysteroscopic sterilization.