Essure Surgical Removal and Subsequent Resolution of Chronic Pelvic Pain: A Case Report and Review of the Literature

Abstract

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.

Resolution of Chronic Pelvic Pain and Abnormal Uterine Bleeding After Essure® Surgical Removal and Laparoscopic Sterilization: A Case Report

“…Pelvic pain is the main symptom described. This potential side effect has been reported in the literature and can be due to the misplacement of the device [5]. Yunker reported an incidence of 8.1% regarding acute pelvic pain after hysteroscopic sterilization and an incidence of 4.2% regarding persistent pain 3 months or greater after hysteroscopic sterilization [4].…”

“…Essure ® is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction [5]. Some women subsequently choose to have inserts removed for perceived side effects.…”

“…Complications of the procedure are malpositioning, unintended pregnancy, abnormal uterine bleeding, infections, chronic pelvic pain, and some patients subsequently choose to remove the tubal inserts for perceived side effects [5]. We present a case of complete resolution of symptoms after the Essure ® surgical removal.…”

Pelvic Congestion Syndrome in a Postmenopausal Female

“…The pelvic pain continued to worsen until she requested to have the device removed through a laparoscopic bilateral total salpingectomy. After removal, the patient conclusively reported that the chronic pelvic pain resolved itself [ 11 ]. It is possible that her pain was related to this device as well.…”

Best practices for evaluating pelvic pain in patients with Essure tubal occlusion devices

“…Multiple case reports demonstrate pain due to Essure misconfiguration or perforation with subsequent resolution of symptoms after device removal. 18,20,21 A case study by Alcantara and colleagues described a patient with chronic pelvic pain and an Essure coil that was curved in an elliptical shape, not adhering to the anatomic course of the fallopian tube. The patient reported pain resolution after laparoscopic removal of the device.…”