We present three unusual complications of laparoscopic sterilisation with clinical presentation, pathology and management. We discuss the possible aetiological factors, pathogenesis and clinical importance in relation to each case.
PIP: 3 unusual late complications of laparoscopic sterilization, previously unreported, are described. The 1st woman had a laparoscopic sterilization by placement of 4 Filshie clips 2 years before. She was admitted with fever, tenderness in the right iliac fossa, but a normal pelvic examination. Laparotomy revealed appendicitis, with a Filshie clip within the lumen, associated with transmural inflammation distal to the clip. 2 clips were located, 1 on each tube, on x-ray. The remaining clip was not seen. The 2nd case was a 30-year old woman who had been sterilized 3 days before, with intestinal obstruction caused by prolapse of a loop of distal ileum through a defect in the broad ligament. The 3rd woman, who had been sterilized a year ago at age 36, described tender swelling below the umbilicus that became painful during menses. The lesion, thought to be a paraumbilical hernia, was a solid nodule of typical endometrial glands and stroma with a fibrous scar. While endometriosis in the umbilical skin has been observed in a surgical scar, none have been reported after laparoscopy. It would be wise not to perform laparoscopy during menstruation.