Clinical management controversy caused by a rare case of silver clip detachment and displacement after tubal sliver clip sterilization

Abstract

The treatment of rare long-term complications such as ectopic silver clips after tubal silver clip sterilization, still follows the principle of removing metal foreign body(MFB) in the abdominal cavity: first choice removal, which seems to be a habitual treatment method by clinical gynecologists. However, this measure has recently been greatly questioned. A 54-year-old postmenopausal woman who had undergone tubal sterilization with a sliver clip 32 years ago, presented to emergency department(ED) with severe left upper abdominal colic, paroxysmal, accompanied by vomiting and radiating pain. Her vital signs were stable and emergency routine urine test showed microscopic hematuria. Preliminary consideration was given to ureteral stones and abdominal pain was relieved after treatment. Abdominal CT confirmed the previous consideration, but unexpectedly found that the left tubal sterilization metal clip disappeared and was ectopic in the perihepatic space. This traditional conception of removing metal foreign body(MFB) in the abdominal cavity is often accepted by many surgeons. Based on the management measures of this case and the systematic review of literature, we found that the detached ectopic silver clip did not cause serious long-term complications, possibly due to its good tissue receptivity and other characteristics. Although an ectopic silver clip is a MFB in the abdominal cavity, it has been increasingly shown that removing the silver clip is not necessary because of the good receptivity of silver to human tissue and uncertainty of long-term side effects on human body.