Lora Alcantara Isamarie, Rezai Shadi, Kirby Catherine, Chadee Annika, Henderson Cassandra E, Elmadjian Malvina
Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, NY 10451, USA.
West Virginia School of Osteopathic Medicine (WVSOM), Lewisburg, WV 24901, USA.
Case Rep Obstet Gynecol. 2016;2016:6961202. doi: 10.1155/2016/6961202. Epub 2016 Jan 24.
Background. Hysteroscopic tubal sterilization (Essure) is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device. Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device. Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement.
背景。宫腔镜输卵管绝育术（Essure）是一种用于永久性避孕的微创方法，据报道患者满意度较高。一小部分接受该手术的女性后来因后悔或感觉到诸如因放置Essure装置继发迟发性盆腔疼痛等副作用而选择取出输卵管植入物。病例。一名29岁女性，孕4产4（0次流产，1次早产，4次足月产），在宫腔镜下放置Essure装置进行绝育术后两年，出现慢性盆腔疼痛和性交困难的症状。在查看子宫输卵管造影（HSG）图像时，注意到虽然确认输卵管闭塞，但左侧Essure线圈呈椭圆形自行弯曲，似乎未遵循输卵管预期的解剖轨迹。患者报告在腹腔镜下取出Essure装置后慢性盆腔疼痛得到缓解。结论。对于放置Essure装置困难的女性，在慢性盆腔疼痛的鉴别诊断中应考虑到Essure装置位置不当的情况。除了显示输卵管闭塞外，在HSG检查中仔细检查Essure微植入物的形态，可为放置Essure装置后出现盆腔疼痛的患者提供有价值的信息。
