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A 49-year-old female was electively admitted for a ventral incisional hernia repair. She had a laparotomy 10 years ago for adhesions and a preoperative MRI of the abdominal wall showed a hernia at the level of the umbilicus as well as a foreign body suture-like material related to previous surgery.
Intraoperatively there was a loose Filshie clip external to the hernia sac presumably from her previous sterilisation 15 years ago. Indeed, comparing her preoperative and postoperative x rays showed that the free clip in the abdomen had been removed (figs 1–3). The x rays show migration of one of the clips.
Abdominal x ray 7 months before operation shows two clips in the left side of the pelvis.
Abdominal x ray 1 month before the operation shows a clip in the left iliac fossa and one within the left side of the pelvis.
Pelvic x ray 2 days postoperatively shows a clip within the left side of the pelvis close to the midline as well as the clips used to close the incisional hernia repair.
Tubal occlusion using the Filshie clip has been used worldwide for over 25 years. It is an effective method of female sterilisation. The Royal College of Obstetricians and Gynaecologists’ evidence-based guidelines recommend that women should be informed that tubal occlusion is associated with a lifetime risk of failure, which in general is estimated as 1 in 200.1 A possible cause of failure is clip migration, which is an unusual complication. On the other hand, clip migration does not necessarily mean failure of the sterilisation procedure. Our patient had no serious consequences arising from the clip migration.
It is important to inform the patient of the potential reversibility of sterilisation as there are medico-legal consequences of failure.2 Also, plain abdominal x rays in women with tubal clips should be carefully examined.
Footnotes
Competing interests: none.
Patient consent: Patient/guardian consent was obtained for publication.