Migration of a tubal ligation clip causing chronic perianal sinus: An unrecognized complication of floating clips

Tubal clip migration is a relatively uncommon phenomenon. When migration occurs, there is a surprisingly diverse range of presentations. We report a case of a 41-year-old woman who presented with an apparent fistula-in-ano. Initial clinical assessments failed to delineate the course of the tract, and subsequent radiology showed this to be a simple sinus. The sinus failed to heal and eventually further radiology demonstrated that the source of the infection, leading to the discharging sinus, was a tubal ligation clip that had migrated from the pelvis to the para-rectal tissue. The clip was eventually removed by a combination of abdominal laparoscopic and radiologically guided perineal approaches. A discussion of the implications of the incidence of clip migration together with the prevalence of clip-sterilized women follows. © 2007 Lippincott Williams & Wilkins, Inc.