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. 2018 Jul 12;91(1090):20170686. doi: 10.1259/bjr.20170686

Figure 15.

Figure 15.

A 37-year-old nulliparous female who underwent bilateral Essure placement. A second hysterosalpingography was required six months after the procedure because of bilateral tubal patency in the first follow-up. (a) Scout image showing an asymmetrical aspect of the inserts with a curved left insert (arrow). (b) Hysterosalpingogram showing proper placement of the two inserts and persistent left tubal patency. The lateral end of the left insert (arrow) deviates from the trajectory of the contrast filled ampulla and infundibulum of the fallopian tube (arrowhead) which is consistent with tubal perforation. Laparoscopic tubal ligation was performed and confirmed tubal perforation with subserosal misplacement of the left insert. (c) Illustration depicting the tubal perforation with the left insert deviating from the course of the fallopian tube.