Replies to This Discussion

Permalink Reply by William Brown on March 17, 2011 at 12:47pm

Image 1, the coronal view of the uterus, to me appears to give the best and most decipherable information. 

The most cephalad device has the appearance of the wound-down inner coil; if more than 50% of this coil trails within the cavity, this would fit the criteria for "proximal placement" and the patient should not rely on Essure for her sole source of contraception (per the manufacturer, Conceptus, even if HSG showed occlusion).

The more caudal wire has a looped appearance and likely represents significant unwound outer coil lying in the cavity.  There is not good data to either support or deny that trailing inert coils in the endometrial cavity are associated with abnormal uterine bleeding, although persistent AUB after Essure in general is felt to be a rare occurrence.  It would be interesting to read the insertion procedure note to see if any difficulties were described, especially detachment difficulties with the delivery wire.

 

Buzz Brown

Denver Health

Permalink Reply by Viviane Connor on March 21, 2011 at 8:18am

I am fairly certain the inner coil is located in the endometrial cavity and the outer coil is in the tube.  The patient cannot rely on this insert for sterilization.  I believe this also accounts for the abnormal bleeding she is having.  I would recommend hysteroscopic removal, and perhaps reinsertion. 

 

What were the circumstances of the original procedure?  Was it difficult, or did it take longer than 10 minutes?  I would really be interested to know.  Thanks.

Permalink Reply by Dr.Muhammad Bashir Malik on March 21, 2011 at 9:25am

Hi

I think first coronal view showing that the part of device is piercing the left lateral wall, even it may be the case of double device mean previous misplaced with a new inserted device.

Pt needs radiogrtaphic evaluation.