Fluoroscopy-guided removal of a migrated non-palpable implanon adherent to the ulnar nerve: a case report

Category	Detail
Condition
Key Mechanisms
Target Population	Women aged 18-45 with etonogestrel implants experiencing complications
Care Setting

Etonogestrel implants can migrate and become non-palpable, complicating removal.
Fluoroscopy guidance was successfully used after unsuccessful ultrasound attempts.
The implant was located adjacent to the ulnar nerve, posing a risk for nerve injury.
Patient reported resolution of transient tingling sensation post-procedure.
Accurate localization and specialist referral are critical for safe removal.
Imaging techniques are essential for localization of non-palpable implants.

Use imaging techniques for localization of non-palpable implants, such as ultrasound or fluoroscopy.

Consider fluoroscopy guidance for removal of deeply placed or migrated implants.

Continuous neurological monitoring during surgical procedures near critical structures.

Potential for neuropathy, vascular injury, and other complications from migration.

Women with a history of etonogestrel implant placement and complications.

Fluoroscopy-guided removal is effective when conventional methods fail.

Avoid epinephrine in local anesthesia to prevent ischemia near neurovascular structures, as it can constrict blood vessels and reduce blood flow.
Utilize hydrodissection cautiously to protect adjacent nerves during dissection.
Employ intermittent fluoroscopy to minimize radiation exposure during procedures.

Clinical Scorecard: Ultrasound-Assisted Extraction of a Non-Palpable Etonogestrel Implant Adhering to the Ulnar Nerve: A Case Study