Clinical Report: Ultrasound-Assisted Extraction of a Non-Palpable Etonogestrel Implant

Overview

This report details the successful extraction of a non-palpable etonogestrel implant adhering to the ulnar nerve using fluoroscopy guidance after unsuccessful attempts with ultrasound. The case emphasizes the importance of accurate localization and specialist referral in complex implant removals.

Background

Subdermal etonogestrel implants are effective contraceptives but can lead to complications such as migration and non-palpability, particularly near neurovascular structures. Approximately 3-5% of implants may become non-palpable, necessitating advanced imaging techniques for safe removal. Understanding the challenges associated with these implants is crucial for healthcare providers to prevent potential nerve injuries and ensure patient safety.

Data Highlights

Key Findings

• The patient presented with persistent abnormal bleeding three years post-etonogestrel implant placement.
• Previous removal attempts failed due to the implant's deep positioning and migration.
• Ultrasound guidance and hydrodissection were unsuccessful in localizing the implant.
• Fluoroscopy guidance successfully facilitated the extraction of the implant adhering to the ulnar nerve.
• The patient experienced transient tingling during the procedure, which resolved by the two-week follow-up.
• Accurate localization and referral to specialists are critical for safe removal of deeply placed implants.

Clinical Implications

Clinicians should be aware of the potential complications associated with etonogestrel implants, particularly in cases of migration. When faced with non-palpable implants, it is essential to utilize imaging techniques and consider referral to specialists to minimize risks of nerve injury during removal.

Conclusion

This case underscores the effectiveness of fluoroscopy-guided removal of non-palpable etonogestrel implants when conventional methods fail. It highlights the need for careful planning and specialist involvement in complex cases to ensure patient safety.

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