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Case Report
Spontaneous anterior abdominal wall expulsion of female sterilization Filshie clips
1 BA, MA, MBBS, Medical Officer, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
2 MD, MRCOG, Registrar, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
3 MBBS, MMed, MRCOG, FAMS, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
Address correspondence to:
Hui Men Selina Chin
Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Road, 169608,
Singapore
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Article ID: 100090Z08HC2021
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How to cite this article
Chin HMS, He S, Lim SK. Spontaneous anterior abdominal wall expulsion of female sterilization Filshie clips. J Case Rep Images Obstet Gynecol 2021;7:100090Z08HC2021.ABSTRACT
Introduction: Filshie clip ligation is a common procedure for female sterilization. Rarely, Filshie clips may dislodge and migrate through tissue planes (0.6%) involving bladder, appendix, inguinal canal, vagina, urethra, and rectum. The pathophysiology is unclear. We discuss a case of delayed Filshie clip expulsion from the anterior abdominal wall.
Case Report: A 35-year-old Chinese lady presented with a few-month history of a 6 × 5 cm superficial, firm, tender, and mobile infra-umbilical lump with purulent discharge and surrounding erythema. She was afebrile and her inflammatory markers were not raised. Obstetrical history included three lower segment caesarean sections via Pfannenstiel incision, and Filshie clip postpartum sterilization three years ago. She denied other medical or surgical history. Computerized tomography showed a 2.1 cm hyper-dense soft tissue in the infra-umbilical anterior abdominal wall containing two ligation clips. She opted for conservative management with antibiotics. The clips expelled spontaneously from the abdominal lump in succession over the next month—both were closed and complete. Subsequent hysterosalpingography showed abrupt truncation in bilateral fallopian tubes with no peritoneal spillage.
Conclusion: Spontaneous anterior abdominal wall expulsion of Filshie clips is a rare complication of tubal ligation that may occur from weeks to years after. When patients are counseled pre-operatively, risks of clip migration and expulsion should be discussed. Sterilization history should also be sought in females presenting with abdominal pain.
Keywords: Expulsion, Filshie clip, Migration, Tubal ligation
SUPPORTING INFORMATION
Author Contributions
Hui Men Selina Chin - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Song He - Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Shau Khng Lim - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Hui Men Selina Chin et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
