Twice-failed tubal ligation: a case report

Abstract

The case is presented of a twice-failed tubal ligation in a woman with six previous children. The first failure followed laparoscopic tubal occlusion by silastic falope rings, while the second failure was subsequent to tubal ligation and division via minilaparotomy. No similar reports have been reported in the East African Literature. Possible reasons for failure are discussed.

PIP: A case of 2 failed tubal ligations in a para 6 Kenyan woman is described. She had an interval laparoscopic sterilization with silastic rings after delivery of her 6th child at age 38. After 3 menstrual periods she became pregnant. She decided to be sterilized again after delivery of her 7th child, a 3.5 kg male. Because of moderate obesity, a minilaparotomy with intravenous anesthesia was performed. The right fallopian tube was only partially occluded with a silastic ring, but the left tub was properly occluded. A Pomeroy tubal ligation was done, excising 2 cm of each tube, and ligating with No. 1 catgut. The woman experienced 2 more menses, and conceived again. She was delivered of a term female, and submitted to a hysterosalpingogram, which showed a tubal-peritoneal fistula on the right. The woman expressed fatalism about future childbearing, and eventually refused to return for contraceptive care or another sterilization.