Spontaneous extrusion of a migrating Filshie clip through the anterior abdominal wall

Case report A 33-year-old para 3+3 presented to the Accident and Emergency department with complaints of increasing pain over an abdominal lump of 3 weeks’ duration, and a greenish purulent discharge for 3 days. On examination the lump had the appearances of a discharging abscess located approximately 5 cm below the umbilicus and a solitary Filshie clip was spontaneously extruded. She was treated with a course of antibiotics and the area was completely healed within a fortnight. X-rays before and subsequent to the clip extrusion are shown in Figures 1, 2 and 3. Five years previously a laparoscopic sterilisation procedure had been attempted on her, which was converted to a laparotomy as there were dense omental and bowel adhesions rendering the tubes inaccessible laparoscopically. The Filshie clips were applied to each tube under direct vision at lapartomoy and she had an uneventful recovery. Before this she had had three first-trimester miscarriages, two lower segment caesarean sections and a normal vaginal delivery. Discussion Approximately 90 000 women are sterilised in the United Kingdom each year. Since 1981 the Filshie clip has been safely and acceptably used, being the preferred method for 67% surgeons in Scotland and 82% of those in England (Filshie, 1999). The suggested incidence of clip migration varies from 0.6 per 1000 cases (Coker et al., 1998) to well over 20% innocent migration of clips (Filshie, 1999). Considering that in excess of 3 million pairs of Filshie clips have been used, only a handful of cases with such problems have been reported in the literature. Filshie clips applied to fallopian tubes have been retrieved after migration to a femoral hernia (Garner et al., 1998), to the inguinal canal (Scheel-Hincke and Berendtson, 1994), to the urinary bladder (Kesby and Korda, 1997; Klumper and Peters, 1991), and to the vaginal vault after vaginal hysterectomy (Buckett et al., 1998). A case of recurrent pelvic abscess due to a detached Filshie clip that was expelled at the time of incision and drainage has been reported a decade ago (Robson and Kerin, 1993). This is the first reported case of a migrated Filshie clip extruded spontaneously through the anterior abdominal wall. There has been a report of Filshie clip migration into the common bile duct and consequent calculus formation after laparoscopic cholecystectomy, where it is used to ligate the cystic duct (Muehlenberg and Loffler, 1995). Transuterine migration and spontaneous vaginal explusion of Hulka clips have been reported (Gooden et al., 1993) besides their spontaneous extrusion through the vault after vaginal hysterectomy (Barker and Roberts, 1997).