Migrated tubal sterilisation clip presenting as a subcutaneous gluteal foreign body 24 years later: a case report and literature review

Abstract

Background: The incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or spontaneous extrusion. Here we present a rare case of sterilisation clip migration through the entire pelvic floor.

Case presentation: A 66-year-old female was referred from community to the Surgical Emergency Unit with a possible metallic foreign body under the skin following an attempted routine gluteal cyst excision. The patient first noticed a lump under the skin 2 years ago which gradually became more apparent and tender over the previous 2 months. The patient denied recent trauma, had no co-morbidities and had a sterilisation procedure 24 years prior. Examination revealed a non-mobile solid structure just beneath the skin 5 cm laterally from the anal verge. Inflammatory markers were normal and an ultrasound confirmed a 15 × 7 mm foreign body in the subcutaneous tissues. The foreign body was excised easily under local anaesthesia, revealing a closed Filshie sterilisation clip. The wound was closed primarily, and recovery was uncomplicated.

Conclusions: This was a case of sterilisation clip migration to the subcutaneous gluteal region. A literature review revealed 34 case reports of sterilisation clip migration, mostly to the bladder. Patients with a previous sterilisation procedure and suspected subcutaneous foreign body without trauma should elicit a high index of suspicion for migrated sterilisation clips. These clips can migrate through multiple layers of muscle and fascia, including the pelvic floor.

Keywords: Clip migration; Filshie; Pelvic floor; Sterilisation; Subcutaneous foreign body; Tubal clip migration; Tubal ligation.

Fig. 1

Illustration of location of foreign body palpated during examination, marked with a cross, on an image adapted from https://theodora.com/anatomy/surface_anatomy_of_the_lower_extremity.html

Fig. 2

Admission ultrasound image showing foreign body in the subcutaneous tissue of the posteromedial left thigh

Fig. 3

Proportion of reports of migration by anatomical location

Fig. 4

Variation in time to acutely presenting with clip migration symptoms following sterilisation procedure