Filshie Clip Migration Case Report From Canada

Filshie Clip Migration Case Report From Canada: A Filshie clip migration case report from Canada entitled “Migrated Tubal Ligation (Filshie) Clip as an Uncommon Cause of Chronic Abdominal Pain” states: “Tubal ligation (TL) is an eective 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.”

The authors of the case report provided the following details regarding a Filshie clip migration case in Canada: “A 49-year-old female was referred to the General Surgery Clinic with a 3.5-year history of intermittent left upper quad-rant (LUQ) pain. She described her symptoms as a dull localized pain with gradual onset lasting on average 2-3 days. When present, the pain uctuated in intensity throughout the day. This pain was noncyclic and had no identiable triggers. There was no history of trauma to the area. The pain was not reproducible with palpation of the area. She was unable to nd any provoking or palliative factors or positions. Her longest pain-free period was recalled to be approximately 4 days. There were no other associated symptoms.”

“Prior to 3.5 years ago, the patient never had any episodes of similar symptoms. There was no history of unintentional weight loss, fevers, or night sweats. Upon physical exam, the patients abdomen had no rebound, guarding, or overlying skin changes. Prior to the onset of the pain, the patient had undergone an uncomplicated laparoscopic TL with Filshie clips in 1999 and a vaginal hysterectomy in 2013. Initially, the patients pain was thought to be of gastrointestinal origin for which she underwent a gastroscopy and colonoscopyboth revealing no pathology. The patient was involved in a motor vehicle accident one year prior to presentation at our clinic and during workup of symptoms related to the collisionan incidental nding of one migrated tubal ligation clip was made on plain lm. The clip was noted to be present underneath the diaphragm adjacent to the stomach. A subsequent CT scan localized the clip adjacent to the liver, embedded in the gastrohepatic ligament of the liver. There was no other abdominal pathology revealed on imaging.”

“A diagnostic laparoscopy with the intent of identifying and removing the clip was undertaken. The Filshie clip was seen underneath the left lobe of the liver embedded in the gastrohepatic omentum and was subsequently excised using bipolar diathermy. No other potential causes of her LUQ pain were identied during laparoscopy. The patient was contacted at a 5-week postop and again 3.5 months later and found to be completely symptom-free.”

Filshie Clip Migration

“The mechanism of Filshie clip migration is thought to be closely related to its mechanism of function. Filshie clip application occludes the nearby vascular structures leading to avascular necrosis. Two blind stumps of the previously continuous structure remain after application, with one stump containing the Filshie clip with its jaws closed. It is theorized that peritoneal growth and adhesion formation of the clip-containing stump encloses the Filshie clip preventing migration. If this fails to occur, migration of the Filshie clip may occur  The inammatory capsule and adhesions observed surrounding the Filshie clip in this case further support the idea of a localized inammatory tissue reaction.”

“There has been an increasing trend towards bilateral salpingectomies over tubal ligation for the purposes of permanent contraception. This is in light of a potential preventative role in the development of ovarian cancer by removing fallopian tubes which may be a source of origin for epithelial ovarian cancers. This trend may be a step in the right direction given the high estimated rate of Filshie clip migration and potential complications that may arise as a result. 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.”

Many of the women who contact us regarding Filshie clips have advised us that they were unaware that Filshie clips were used in their sterilization procedure, which raise possible informed consent issues, and that they would not have agreed to Filshie clips had they been fully informed. Many of these women thought that their Fallopian tubes were going to be cut or “clipped” during their sterilization procedure.

If you or a loved one suffered injury or other harm from Filshie clips in the United States, you should promptly find a medical malpractice lawyer in your state who may investigate your Filshie clip claim for you and represent you or your loved one in a Filshie clip medical malpractice, informed consent, and/or product liability case, if appropriate.

Visit our website or call us toll-free in the United States at 800-295-3959 to find Filshie clip attorneys who may assist you with your Filshie clip claim.

Turn to us when you don’t know where to turn.

This entry was posted on Monday, August 1st, 2022 at 9:49 am. Both comments and pings are currently closed.

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