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. (Fertil Steril (R) 2011; 95: 2429. e15-e17. (C) 2011 by American Society for Reproductive Medicine.)