Fluoroscopy-guided removal of a migrated non-palpable implanon adherent to the ulnar nerve: a case report

Although subdermal contraceptive implants are highly effective, they can create various complications if they migrate or become non-palpable, especially when adjacent to neurovascular structures. Ultrasound guidance and hydrodissection are commonly used to remove migrated implants; however, these techniques are not practical in certain cases. We report the case of a 33-year-old left-handed woman who presented with persistent abnormal bleeding 3 years post-etonogestrel implant placement. The implant was non-palpable upon presentation, and previous removal attempts had failed. Imaging revealed that the implant was located deep in the upper arm, adjacent to the ulnar nerve. Ultrasound guidance and hydrodissection were unsuccessful; therefore, fluoroscopy guidance was used to safely extract the implant, which had adhered to the ulnar nerve. The patient was discharged on the same day. By the 2-week follow-up visit, the incision had healed well, and the patient reported that the transient tingling sensation-which had occurred intraoperatively due to minimal traction during the final dissection-had completely resolved. Fluoroscopy-guided implant removal is effective for the removal of deeply placed or migrated implants, particularly when conventional methods fail; however, accurate localization and referral to specialists are essential for their safe removal.