Abstract
Introduction: Tubal ligation is currently one of the most common contraception methods used globally. The
procedure may be performed laparoscopically or via hysteroscope. It can be performed immediately after childbirth,
in the postpartum period, or at a time unrelated to pregnancy. Advances in technology and changes in social opinion
have contributed to the increasing popularity of tubal ligation as a method of contraception.
Case presentation: A 49-year-old female presented with a three-day history of worsening abdominal pain, mainly
in the right iliac fossa (RIF) with radiation to both flanks. The patient had a history of previous tubal ligation. On
examination her abdomen was soft but tender with maximal tenderness in the RIF. The examination was positive for
rebound tenderness and involuntary guarding. Initial investigations included blood tests which revealed an elevated
white blood cell (WBC) count of 15.8, elevated neutrophils of 13.06, and an elevated CRP of 61.6. Computed tomography of abdomen and pelvis (CTAP) showed a focal inflammatory change in the greater omentum just
superior to the mid transverse colon. Differential diagnoses considered included an omental infarction, diverticulitis
or focal perforation, or a metastatic deposit.
Procedure: The patient was consented and brought to the operating theatre for laparoscopy. On inspection there was
no evidence of omental infarction, diverticulitis, focal perforation, or metastatic deposits. One of the patient’s Filshie
clips was found to be embedded in the greater omentum and was removed with fenestrated grasper and blunt
dissection from the omentum.
Discussion: Tubal ligation is a method of permanent contraception that is growing in popularity for females who
have completed their families. Migrated Filshie clips is a common phenomenon that can result in failure of
contraception, Furthermore, migration of Filshie clips can lead to abscess formation, and acute and chronic
abdominal pain, requiring hospital admission and surgical intervention.
Conclusion: This case report highlights that Filshie clip migration should always be considered as a possible
differential in the patient presenting with acute or chronic abdominal pain with a history of tubal ligation.
Laparoscopy proved to be vital in confirming the diagnosis, highlighting the importance of clinical judgement in the
context of ambiguous CT findings.
Keywords: Tubal ligation; Permanent contraception; Laparoscopy; Migrated Filshie clips
Abbreviations: CRP – C-Reactive Protein; CTAP – Computed Tomography of Abdomen and Pelvis;
D&C – dilation And Curettage; DCIS – Ductal Carcinoma In Situ; FBC – Full Blood Count; GP – General
Practitioner; IV – Intravenous; LFTs – Liver Function Tests; LUTS – Lower Urinary Tract Symptoms;
NPO – Nil Per Os; NSAID – Nonsteroidal Anti-Inflammatory Drug; PPI – Proton Pump Inhibitor; RIF –
Right Iliac Fossa; U&E – Urea and Electrolytes; WBC – White Blood Cell
McAndrew JE, Taha A, Kavanagh R and Haidaran A. Migrated Tubal Ligation Clip Requiring Laparoscopic
Surgical Removal – A Case Report. Mega J Case Rep. 2023;6(12):2001-2012.
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