title: Use of intraoperative fluoroscopy during laparotomy to identify fragments of retained Essure microinserts: case report.
abstract: In previous case-reports of Essure microinsert perforation, the microinsert was successfully removed at laparoscopy. Herein is discussed the scenario of persistent pelvic pain over several years after an apparently successful laparoscopic retrieval of a perforating right-sided microinsert. In the interim, the patient underwent 2 unsuccessful exploratory laparotomy procedures in an attempt to retrieve additional microinsert fragments that had perforated the uterus. Successful management of Essure microinsert perforation in this patient ultimately required use of intraoperative fluoroscopy. Surgeons performing laparoscopy or laparotomy to retrieve Essure microinserts that have perforated should be aware that these are not always visible to the naked eye, and there should be a low threshold to use intraoperative fluoroscopy to ensure that all perforating fragments have been removed.
authors.affiliation: Department of Obstetrics and Gynecology, University of Missouri-Kansas City, MO 64108, USA. howarddav@umkc.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Howard
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Christenson
authors.forename: Julie L
authors.initials: JL
authors.lastname: Strickland
mesh_terms: D000328:Adult; D003274:Contraceptive Devices, Female / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods*; D007430:Intraoperative Care / Q000379:methods*; D007813:Laparotomy; D014595:Uterine Perforation / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*