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Migration of a Subcutaneous Contraceptive Device

  • Omici N. Uwagbai and Arthur C. Wittich
Published/Copyright: September 1, 2016
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 116 Issue 9

A healthy 20-year-old woman presented to the obstetrics and gynecology clinic with complaint of pain in her left upper extremity. The patient had undergone subcutaneous placement of a etonogestrel implant 3 days prior. Physical examination revealed tenderness on palpation to the medial aspect of the left upper arm near the axilla. The implant was superficially palpable, approximately 12 cm cephalad from the insertion scar (image A). A radiographic image revealed a radiopaque rod near the left axilla (image B). A 1-cm skin incision was made, and the device was removed using ultrasound guidance. Another implant was inserted without complication into the right arm 4 days later.

Migration of single-rod subdermal contraceptive implants has been known to occur, typically less than 2 cm from the insertion site.1,2 Rare reports of distant migration from the insertion site have been described.3 Radiographic identification of the device is important for localization and should be obtained before removal. There is no explanation for the migration of the implant in the current patient, as she reported no manipulation or rubbing at the insertion site.

Figure.
Figure.
From the Department of Family Medicine (Dr Uwagbai) and the Department of Obstetrics and Gynecology (Dr Wittich) at Fort Belvoir Community Hospital in Virginia. Dr Uwagbai is a third-year resident.
Disclaimer: The views expressed herein are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the US Government.

* Address correspondence to Omici N. Uwagbai, MD, MPH, Department of Family Medicine, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060-5285. E-mail:

References

1. Ismail H , MansourD, SinghM. Migration of Implanon. J Fam Plann Reprod Health Care. 2006;32(3):157-159. doi:10.1783/147118906777888413.10.1783/147118906777888413Search in Google Scholar PubMed

2. Berhe Y , HagosG, WallLL. Axillary migration of an Implanon® contraceptive rod: case report. Open Access J Contraception. 2014;5:49-51. doi:10.2147/OAJC.S65016.10.2147/OAJC.S65016Search in Google Scholar

3. Heudes P-M , QueratVL, DarnisE, DefranceC, DouaneF, FrampasE. Migration of a contraceptive subcutaneous device into pulmonary artery: report of a case. Case Rep Womens Health. 2015;8:6-8. doi:10.1016/j.crwh.2015.09.002.10.1016/j.crwh.2015.09.002Search in Google Scholar PubMed PubMed Central

Accepted: 2016-04-13
Published Online: 2016-09-01
Published in Print: 2016-09-01

© 2016 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  1. EDITORIAL
  2. Antimicrobial Stewardship and Osteopathic Medicine: A Call to Action
  3. Redefining Competency Domains for Osteopathic Medical Practice
  4. Letters to the editor
  5. Transient Ischemic Attack After Foam Sclerotherapy
  6. ORIGINAL CONTRIBUTION
  7. Multicenter Osteopathic Pneumonia Study in the Elderly: Subgroup Analysis on Hospital Length of Stay, Ventilator-Dependent Respiratory Failure Rate, and In-hospital Mortality Rate
  8. Education and Communication in an Interprofessional Antimicrobial Stewardship Program
  9. BRIEF REPORT
  10. Retropubic Dilation With a Foley Catheter Balloon: A Novel Technique for Penile Prosthesis Reservoir Placement
  11. REVIEW
  12. The Potential of Osteopathic Manipulative Treatment in Antimicrobial Stewardship: A Narrative Review
  13. MEDICAL EDUCATION
  14. Teaching and Assessment of High-Velocity, Low-Amplitude Techniques for the Spine in Predoctoral Medical Education
  15. SPECIAL COMMUNICATION
  16. Nonprofit Board Membership for Health Care Professionals: Honor or Responsibility?
  17. CLINICAL IMAGES
  18. Migration of a Subcutaneous Contraceptive Device
  19. IN YOUR WORDS
  20. Seeing the Future Radiologist Within Me
https://doi.org/10.7556/jaoa.2016.123
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. EDITORIAL
  2. Antimicrobial Stewardship and Osteopathic Medicine: A Call to Action
  3. Redefining Competency Domains for Osteopathic Medical Practice
  4. Letters to the editor
  5. Transient Ischemic Attack After Foam Sclerotherapy
  6. ORIGINAL CONTRIBUTION
  7. Multicenter Osteopathic Pneumonia Study in the Elderly: Subgroup Analysis on Hospital Length of Stay, Ventilator-Dependent Respiratory Failure Rate, and In-hospital Mortality Rate
  8. Education and Communication in an Interprofessional Antimicrobial Stewardship Program
  9. BRIEF REPORT
  10. Retropubic Dilation With a Foley Catheter Balloon: A Novel Technique for Penile Prosthesis Reservoir Placement
  11. REVIEW
  12. The Potential of Osteopathic Manipulative Treatment in Antimicrobial Stewardship: A Narrative Review
  13. MEDICAL EDUCATION
  14. Teaching and Assessment of High-Velocity, Low-Amplitude Techniques for the Spine in Predoctoral Medical Education
  15. SPECIAL COMMUNICATION
  16. Nonprofit Board Membership for Health Care Professionals: Honor or Responsibility?
  17. CLINICAL IMAGES
  18. Migration of a Subcutaneous Contraceptive Device
  19. IN YOUR WORDS
  20. Seeing the Future Radiologist Within Me
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