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Case Reports
. 2020 Jul 7:21:e923661.
doi: 10.12659/AJCR.923661.

An Unusual Case of a Filshie Clip Presenting as a Bladder Wall Abscess 12 Years After Sterilization

Zi Xi Poo  1 , Grace Ng  1 , Shahul Hameed Mohamed Siraj  2
Affiliations
Case Reports

An Unusual Case of a Filshie Clip Presenting as a Bladder Wall Abscess 12 Years After Sterilization

Zi Xi Poo et al. Am J Case Rep. .

Abstract

BACKGROUND There is growing evidence suggesting that Filshie clip migration is a rare but significant late complication following tubal sterilization. Although most women are asymptomatic, clip migration can result in serious morbidity such as abscess formation and be a source of sepsis years later. CASE REPORT A 51-year-old woman presented with 2-week history of worsening right flank pain with fever and chills, unresponsive to oral antibiotics. CT imaging showed a 4-cm anterior bladder wall mass with a tubal ligation clip within, initially suspicious for a tumor, with secondary infection. Cystoscopy was unremarkable and tumor markers were negative. A subsequent CT urography confirmed the finding of right adnexal abscess with ligation clip within, suggesting a diagnosis of pelvic inflammatory disease. Due to failure of conservative management, she underwent a diagnostic laparoscopy, which was then converted to an exploratory laparotomy due to dense omental adhesions. A Filshie clip was found within the bladder wall abscess and removed. An inadvertent bladder dome perforation was repaired. Pain and fever resolved after the operation and she was discharged home on post-op day 4 with an indwelling catheter. A micturating cystogram a month later showed no extravasation of contrast and the catheter was removed. CONCLUSIONS This case report highlights the importance of considering Filshie clip migration as a differential diagnosis vs. pelvic inflammatory disease in women without other risk factors and who had previously undergone tubal ligation. Women should be made aware of this potential, rare late complication and its serious morbidity, which may occur years later.

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Conflict of interest statement

Conflict of interest: None declared

Conflict of interest

None.

Figures

Figure 1.
Figure 1.
Filshie clip within bladder wall abscess in CT kidneys ureters bladder.
Figure 2.
Figure 2.
Filshie clip within bladder wall abscess in CT urography post-contrast.
Figure 3.
Figure 3.
Dense omental adhesions seen on initial diagnostic laparoscopy.
Figure 4.
Figure 4.
A 4-cm anterior bladder wall abscess.
Figure 5.
Figure 5.
Filshie clip seen within bladder wall abscess.
Figure 6.
Figure 6.
Inflamed-looking right fallopian tube posterior to bladder wall abscess.
See this image and copyright information in PMC

References

    1. Filshie GM, Casey D, Pogmore JR, et al. The titanium/silicone rubber clip for female sterilization. Br J Obstet Gynaecol. 1981;88:655–62. - PubMed
    1. Royal College of Obstetricians and Gynaecologists (RCOG) Female sterilisation. Consent Advice No. 3 February 2016.
    1. Amu O, Husemeyer RP. Migration of sterilisation clips: Case report and review. Br J Fam Plann. 1999;25:27–28. - PubMed
    1. Filshie GM. Long-term experience with the Filshie clip. Gynaecol Forum. 2002;7:7–10.
    1. Obstetrics and Gynecology Devices Panel of the Department of Health and Human Services Public Health Service, Food and Drug Advisory panel meeting Feb 26, 1996.

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