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Updated: Jun 4, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
A kink is not always a perforation: assessing Essure hysteroscopic sterilization placement
Jane Borley1, Natasha Shabajee, Toh Lick Tan
1Department of Obstetrics and Gynaecology, Ealing Hospital NHS Trust, London, United Kingdom. janeborley@yahoo.co.uk
Objective:
To highlight the fallacy of using a kink in the microinsert outline on plain abdominal x-ray as a marker for tubal perforation.
Design:
Case report.
Setting:
West London District general hospital.
Patient(S):
36-year-old Asian woman requesting permanent sterilization.
Intervention(S):
Essure hysteroscopic sterilization followed by abdominal x-ray, pelvic ultrasound, and laparoscopy.
Main Outcome Measure(S):
Absence of tubal perforation.
Result(S):
A patient presented with clinically suspected fallopian tube perforation 3 days after Essure hysteroscopic sterilization. Her transvaginal scan was inconclusive, but the plain x-ray demonstrated a kink within the left microinsert outline. Diagnostic laparoscopy did not identify a perforation, and bilateral tubal placement was confirmed after salpingectomy.
Conclusion(S):
This case highlights the difficulty of relying on imaging in the acute setting to establish a diagnosis of tubal perforation after hysteroscopic sterilization.
