Obstet Gynecol Sci.  2017 May;60(3):314-317. 10.5468/ogs.2017.60.3.314.

Migration of a contraceptive subdermal device into the lung

• Choi JH
• Kim HY
• Lee SS
• Cho S

• KMID: 2378595
• DOI: http://doi.org/10.5468/ogs.2017.60.3.314

Abstract

A single-rod subdermal contraceptive implant is usually located around the insertion site, has been usually known to migrate within less than 2 cm of the insertion site and the true migration over 2 cm has been rarely reported. We report a case of migrated radiopaque subdermal contraceptive implant into lung in a 37-year-old woman. On conducted chest computed tomography, subdermal contraceptive implant was in subsegmental branch in left posterior basal segment of lung. Removal of subdermal contraceptive implant in left posterior basal segment of lung by mini-thoracotomy was performed by a chest surgeon. Complications with insertion and removal of subdermal contraceptive implant are rare in the hands of medical professionals familiar with the techniques and these procedures should only be undertaken by those with relevant training. The migration over 2 cm should not occur if the correct subdermal insertion procedure is followed and carried out by a properly trained individual.

Keyword

Contraceptive implant; Drug implant; Foreign-body migration

MeSH Terms

Adult
Female
Foreign-Body Migration
Hand
Humans
Lung*
Thorax

Figure

• 

  Fig. 1 (A) Long bone upper extremity standing anterior posterior lateral X-ray showing a linear opaque structure (arrow) in pulmonary hemi-right field. (B) Non-contrast chest computed tomography showing that the foreign body (arrow) was in left lower lobe (probably in subsegmental pulmonary artery branch in left posterior basal segment).

• 

  Fig. 2 (A) Mini-thoracotomy was performed by a chest surgeon. Left lower lobe was retracted by lung clamp, then subdermal contraceptive implant (arrow) was exposure. (B) The 4-cm-sized subdermal contraceptive implant was removed.

Reference

1. Balogun OR, Olaomo N, Adeniran AS, Fawole AA. Implanon sub-dermal implant: an emerging method of contraception in Ilorin, Nigeria. J Med Biomed Sci. 2014; 3:1–5.

2. Croxatto HB, Urbancsek J, Massai R, Coelingh Bennink H, van Beek A. A multicentre efficacy and safety study of the single contraceptive implant Implanon. Implanon Study Group. Hum Reprod. 1999; 14:976–981.

3. Collins DC. Sex hormone receptor binding, progestin selectivity, and the new oral contraceptives. Am J Obstet Gynecol. 1994; 170:1508–1513.

4. Brache V, Faundes A, Alvarez F. Risk-benefit effects of implantable contraceptives in women. Expert Opin Drug Saf. 2003; 2:321–332.

5. Bensouda-Grimaldi L, Jonville-Bera AP, Beau-Salinas F, Llabres S, Autret-Leca E. le reseau des centres regionaux de pharmacovigilance. Insertion problems, removal problems, and contraception failures with Implanon. Gynecol Obstet Fertil. 2005; 33:986–990.

6. Implanon [Internet]. Kenilworth (NJ): Merck & Co.;c2011. cited 2017 Mar 13. Available from: http://www.implanon.com.

7. Edwards JE, Moore A. Implanon: a review of clinical studies. Br J Fam Plann. 1999; 24:3–16.

8. Heudes PM, Querat VL, Darnis E, Defrance C, Douane F, Frampas E. Migration of a contraceptive subcutaneous device into the pulmonary artery: report of a case. Case Rep Womens Health. 2015; 8:6–8.

9. O'Brien A, O'Reilly MK, Sugrue G, Lawler L, Farrelly C. Subdermal contraceptive implant embolism to a pulmonary artery. Ann Thorac Surg. 2015; 99:2254–2255.

10. James P, Trenery J. Ultrasound localisation and removal of non-palpable Implanon implants. Aust N Z J Obstet Gynaecol. 2006; 46:225–228.

11. Diaz S, Pavez M, Miranda P, Robertson DN, Sivin I, Croxatto HB. A five-year clinical trial of levonorgestrel silastic implants (Norplant). Contraception. 1982; 25:447–456.

12. Evans R, Holman R, Lindsay E. Migration of implanon: two case reports. J Fam Plann Reprod Health Care. 2005; 31:71–72.

13. Organon Laboratories. Implanon: summary of product characteristics. place unknown: Organon Laboratories;2003.