title: Location and removal of non-palpable Implanon implants with the aid of ultrasound guidance.
abstract: BACKGROUND
  Implanon insertion appears to be an easy procedure, but in a small minority of cases difficulties have been encountered with removal if the rod is impalpable.
  
  
  METHODS
  Patients were referred to the contraceptive and sexual health service with non-palpable Implanon. Following a clinical assessment and examination of the arm where the implant had been inserted, an ultrasound examination was carried out to identify and locate the implant. These implants were subsequently removed, some under general anaesthesia and others under local anaesthesia.
  
  
  RESULTS
  Twenty-seven patients were referred to the unit with impalpable Implanon rods. In four cases the rods were palpable and were removed in the clinic setting without the need for further intervention. Positive identification of the implants was achieved in 21 of the remaining 23 cases using ultrasound. No implant was detected in two cases and etonogestrel was not demonstrated serologically in either woman, suggesting non-insertion. All 21 Implanon rods identified by ultrasound were successfully removed. In just over 52% of women a previous attempt at removal had been undertaken prior to referral.
  
  
  CONCLUSIONS
  It is possible to identify and locate impalpable Implanon rods with the aid of ultrasound, facilitating their subsequent safe removal. Although previous reports have identified the position of 'lost' implants using ultrasound, this is the first case series to discuss measuring the skin/implant depth. This parameter, together with the precise position of the implant (in muscle or fat), aids removal. All health professionals inserting and removing contraceptive implants should have been appropriately trained.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
authors.forename: Madan
authors.initials: M
authors.lastname: Singh
authors.forename: Diana
authors.initials: D
authors.lastname: Mansour
authors.forename: David
authors.initials: D
authors.lastname: Richardson
mesh_terms: D000328:Adult; D003271:Contraceptive Agents, Female; D020878:Device Removal; D004343:Drug Implants; D005260:Female; D006801:Humans; D014463:Ultrasonography
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants