DOI: 10.1093/bjs/znad241.494 ISSN:

437 Migrated tubal sterilisation clip presenting as a subcutaneous gluteal foreign body 24 years later: A case report and literature review

Adil Siraj Lakha, Andrew Ang, Sarmad Mohammed Salih, Christopher Lewis
  • Surgery

Abstract

Introduction

The incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or spontaneous extrusion. Here we present a rare case of sterilisation clip migration through the entire pelvic floor.

Case

A 66-year-old female was referred from community to the Surgical Emergency Unit with a possible metallic foreign body under the skin following an attempted routine gluteal cyst excision. The patient first noticed a lump under the skin 2 years ago which gradually became more apparent and tender over the previous 2 months. The patient denied recent trauma, had no co-morbidities and had a sterilisation procedure 24 years prior. Examination revealed a non-mobile solid structure just beneath the skin 5cm laterally from the anal verge. Inflammatory markers were normal and an ultrasound confirmed a 15x7mm foreign body in the subcutaneous tissues. The foreign body was excised easily under local anaesthesia, revealing a closed Filshie sterilisation clip. The wound was closed primarily, and recovery was uncomplicated.

Discussion

This is the first reported case of sterilisation clip migration to the subcutaneous gluteal region. A literature review revealed 35 case reports of sterilisation clip migration, mostly to the bladder.

Patients with a previous sterilisation procedure and suspected subcutaneous foreign body without trauma should elicit a high index of suspicion for migrated sterilisation clips. These clips can migrate through multiple layers of muscle and fascia, including the pelvic floor.

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