Localization of contraceptive implant capsules for removal.

ABSTRACT

PIP: In Oregon, since some physicians could not remove contraceptive implant (Norplant) capsules, they referred three patients to Oregon Health Sciences University or the Kaiser Sunnyside Medical Center in Clackamas for implant removal. The physician was able to initially remove five of the six capsules in a 21-year-old mother of three. One month later, the physician tried again to remove the remaining capsule and did not succeed. Anteroposterior and lateral radiographs of the upper left arm could not detect the 6th capsule. The referral institution obtained a single anteroposterior radiograph (about 55 kVp and 10 mAs) that revealed the capsule in the subcutaneous tissue. Using landmarks on the radiograph, the capsule's location was estimated and scanned with a high frequency linear ultrasound probe that found the exact location of the capsule. The physicians marked the patient's skin along the length of the capsule and asked her to renew the mark every day until her own physician could remove it two days later. The complete imaging procedure lasted only 12 minutes. Two different surgeons attempted removal of three capsules in one woman. The second surgeon even used 15 minutes of intraoperative fluoroscopy. Another case was referred for imaging because her physician could not palpate one capsule. The referral institution used the same localization method (radiograph and ultrasound) to locate the capsule and mark its location. These cases show that clinicians can perform this inexpensive and effective localization method for undetectable implant capsules quickly. Localization of capsules and removal procedures can be scheduled at different times.