Sharma Sahil, Martyniak Radek, Khokhotva Vladislav
Schulich School of Medicine, Western University, Canada.
Case Rep Surg. 2020 Feb 10;2020:4809859. doi: 10.1155/2020/4809859. eCollection 2020.
Tubal ligation (TL) is an effective and common method of fertility control. In the year 2009, over 24,000 were performed in Canada alone. Migration of Filshie clips used during TL is estimated to occur in 25% of all patients; 0.1-0.6% of these patients subsequently experience symptoms or extrusion of the clip from anatomical sites such as the anus, vagina, urethra, or abdominal wall. Migrated clips may present as chronic groin sinus, perianal sepsis, or chronic abdominal pain. These symptoms can occur as early as 6 weeks or as late as 21 years after application. We present the case of a 49-year-old female with a 3.5-year history of intermittent dull nonradiating left upper quadrant (LUQ) pain lasting on average 2-3 days. There were no other associated symptoms, and the longest pain-free period was 4 days. Her past medical history includes COPD, GERD, IBS, and depression. Current medications are only remarkable for Symbicort. Pertinent past surgical history includes laparoscopic tubal ligation with Filshie clips in 1999, followed by a vaginal hysterectomy in 2013. Migrated tubal ligation clip was noted on an abdominal X-ray. The patient was then referred for surgical management. Subsequent CT scan confirmed a solitary clip present adjacent to the left lobe of the liver. No other abnormalities were reported. Patient underwent laparoscopy for removal of the clip, which was identified to be underneath the left lobe of the liver embedded in the gastrohepatic omentum. Please see the video link provided. Postoperative pathology report confirmed the presence of a Filshie clip. Patient reported complete resolution of her LUQ pain at a 5-week and 3.5-month follow-up. This case shows that although symptomatic clip migration is a rare phenomenon, it should be given special consideration in women with unexplained chronic abdominal pain and a history of TL. Additionally, removal of clip can provide resolution of symptoms.
输卵管结扎术（TL）是一种有效且常用的节育方法。仅在2009年，加拿大就进行了超过24000例该手术。据估计，输卵管结扎术中使用的菲氏夹移位在所有患者中的发生率为25%；其中0.1% - 0.6%的患者随后会出现症状，或夹子从肛门、阴道、尿道或腹壁等解剖部位脱出。移位的夹子可能表现为慢性腹股沟窦道、肛周脓毒症或慢性腹痛。这些症状最早可在应用夹子后6周出现，最晚可在21年后出现。我们报告一例49岁女性病例，她有3.5年间歇性左上腹（LUQ）隐痛病史，疼痛无放射，平均持续2 - 3天。无其他相关症状，最长无痛期为4天。她的既往病史包括慢性阻塞性肺疾病（COPD）、胃食管反流病（GERD）、肠易激综合征（IBS）和抑郁症。目前用药仅思力华有显著效果。相关既往手术史包括1999年腹腔镜下用菲氏夹行输卵管结扎术，随后在2013年行阴道子宫切除术。腹部X线检查发现输卵管结扎夹移位。随后患者被转诊接受手术治疗。后续的CT扫描证实肝脏左叶旁有一个孤立的夹子。未报告其他异常情况。患者接受了腹腔镜手术取出夹子，发现夹子位于肝脏左叶下方，嵌入胃肝韧带中。请查看提供的视频链接。术后病理报告证实存在一个菲氏夹。患者在5周和3.5个月的随访中报告左上腹疼痛完全缓解。该病例表明，尽管有症状的夹子移位是一种罕见现象，但对于有不明原因慢性腹痛且有输卵管结扎术病史的女性应予以特别考虑。此外，取出夹子可缓解症状。
