Spontaneous vaginal expulsion of a Filshie clip.

Dear Editor, Laparoscopic sterilisation is a common method of permanent contraception. The Filshie clip system is a safe and effective method of female sterilisation. Being used around the world for more than 20 years, this form of contraception continues to be the method of choice for many physicians and patients due to the ease and simplicity of application and minimal tube damage produced. Nevertheless, failures are known to have happened. The Royal College of Obstetricians and Gynaecologists’ evidence-based guidelines recommended that the Filshie clip failure rate be quoted as 1 in 200.1 One reason for failure is clip migration. We present a case where the migrated Filshie clip was expelled per vaginum. A 32-year-old woman, who has 2 children, appeared at the gynaecology clinic, with a history of having passed a Filshie clip per vaginum the previous night. She had undergone post -partum sterilisation via a mini-laparotomy 5 years ago. The procedure was uncomplicated and the post-operative period was uneventful. Now, 5 years later, during her menstruation, the woman passed out the clip per vaginum. She brought the clip to the clinic; it was still in a locked position. During examination, no defect was found in any of the vaginal fornices; but there was 1 tender spot in the posterior fornix. A hysterosalpingogram was arranged for her. The abdominal cavity was surveyed under fluoroscopy prior to dye injection. Only 1 Filshie clip was noted in the entire abdominal cavity. This was in the right hemipelvis. After Lipoidal injection, there was opacification of both the fallopian tubes but there was no spillage into the peritoneal cavity (Fig. 1). The remaining Filshie clip was noted to be off the tube and in a closed position. The patient was informed of these findings. She elected to do nothing despite counselling that she might be at risk of getting pregnant again. Sterilisation is a common mode of contraception for women who have completed their families. The Filshie clip system has been used for female sterilisation for more than 20 years. Rioux and Yuzpe2 have reported an overall failure rate of 0.27% for interval procedures and 0.9% for post-partum procedures. The Filshie clip, made of titanium, is lined with silicon rubber. After the clip is applied over the fallopian tube, the soft silicone lining is compressed. The part of the tube between the jaws of the clip undergoes avascular necrosis. The silicone then expands to keep the lumen closed. Over time, peritoneal tissue grows over the clip, thereby holding the clip in place. Occasionally, this process of peritoSpontaneous Vaginal Expulsion of a Filshie Clip