Subserosal misplacement of Essure^* device manifested by late-onset acute pelvic pain

Objective: To increase awareness of the potential to present with late-onset acute pelvic pain secondary to subserosal misplacement of an Essure device (Conceptus Inc., Mountain View, CA). Design: Case report. Setting: University-affiliated teaching hospital. Patient(s): A 30-year-old woman who was seen with severe left lower quadrant pain 4 months after elective sterilization with an Essure device placed under local anesthesia. Mild to moderate resistance was encountered in the placement of the device in the left fallopian tube. Intervention(s): Hysterosalpingogram showing patency of the left fallopian tube and operative laparoscopy. Main Outcome Measure(s): Laparoscopic removal of the Essure device with left salpingectomy. Result(s): The patient was free of pain and was discharged home the same day of the laparoscopic procedure. Conclusion(s): This report reinforces the need to consider a misplaced Essure device in the differential diagnosis of late-onset acute pelvic pain in women who had difficult placement of the device.