A kink is not always a perforation: assessing Essure hysteroscopic sterilization placement.

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.