Vaginal expulsion of a Hulka clip. A case report.

The first known case of vaginal expulsion of a Hulka clip has occurred in a 35-year-old Ohio woman. The woman, gravida 5, para 4, abortus 1, underwent laparoscopic Hulka clip sterilization in January 1983, with no complications. She was seen again in March 1984 for symptomatic menometrorrhagia, for which dilation and curettage was performed. At her next gynecological visit in June 1987, the patient brought in a clamped Hulka clip that had been passed through the vagina. The uterus was normal in size, the adnexa were not palpable, and no fistula or iatrogenic openings were observed. The patient had not experienced severe abdominal pain, fever, or gastrointestinal disorder. A hysterosalpingogram showed bilateral blockage of the tubes and one clip on the left side. Clip self-migration should be considered an extremely rare complication of this procedure.