Reporting Filshie Clips on CT Abdomen for Abdominal Pain
In a standard CT abdomen for abdominal pain, Filshie clips should be explicitly documented with their location, number, and any associated findings such as migration, surrounding inflammation, or adjacent organ involvement, as migrated clips can be a rare but treatable cause of chronic abdominal pain.
Key Reporting Elements
When encountering Filshie clips on CT abdomen, your report should include:
Essential Documentation
- Number of clips visualized (typically 2 clips are placed during tubal ligation)
- Precise anatomical location (expected location: bilateral adnexa/fallopian tube stumps)
- Evidence of migration if clips are found away from expected pelvic location
- Associated findings: surrounding inflammation, fluid collections, or proximity to other organs
Clinical Context
Filshie clips are placed during laparoscopic tubal ligation and should normally remain in the adnexa. However, clip migration occurs in approximately 25% of patients, with 0.1-0.6% becoming symptomatic 1, 2. Symptoms can manifest anywhere from 6 weeks to 21 years post-placement 1.
When to Raise Clinical Concern
Red Flags Requiring Specific Mention
Explicitly state in your report if:
- Clips are located outside the pelvis (e.g., upper abdomen, adjacent to liver, embedded in omentum)
- Only one clip is visible when bilateral tubal ligation is documented
- Clips are associated with inflammatory changes, fluid collections, or mass effect
- Clips are embedded in or adjacent to organs (bladder, bowel, peritoneum, liver)
Reporting Template Language
For normal appearance: "Bilateral metallic Filshie clips noted in expected location within the adnexa, without associated inflammatory changes."
For concerning findings: "Solitary metallic Filshie clip identified in [specific location, e.g., left upper quadrant adjacent to left hepatic lobe/gastrohepatic omentum]. Given patient's history of tubal ligation and presenting symptoms of [location] pain, migrated clip should be considered as potential pain etiology. Surgical correlation recommended." 1
Clinical Significance
Why This Matters
While CT abdomen and pelvis with IV contrast is the appropriate initial imaging for nonlocalized abdominal pain 3, migrated Filshie clips represent a specific, surgically correctable cause of chronic pain that can be missed if not explicitly documented.
The evidence shows:
- Migrated clips can cause chronic abdominal pain, groin sinus, or perianal sepsis 1, 2
- Surgical removal provides complete symptom resolution 1
- Clips can migrate to bladder, peritoneum, appendix, vagina, or embed in omentum 2, 4
Common Pitfall to Avoid
Do not dismiss clips as "incidental surgical material." In a patient with chronic or recurrent abdominal pain and history of tubal ligation, migrated clips should be specifically mentioned as a potential pain source, particularly if:
- Pain location corresponds to clip location
- No other acute pathology explains symptoms
- Pain is chronic (months to years) and intermittent 1
Differential Considerations
When clips are noted in unusual locations with associated findings (ascites, elevated CA-125, pleural effusion), consider mentioning potential complications such as inflammatory response or pseudo-Meigs syndrome 4, though these are exceedingly rare.
Practical Approach
- Always document presence and location of clips when visible
- Count the clips - absence of expected clips may indicate migration
- Correlate location with pain - if patient has LUQ pain and clip is in LUQ, explicitly state this correlation
- Recommend surgical correlation when clips are in abnormal locations with corresponding symptoms
- Review surgical history if available - knowing clip placement helps identify migration
This approach ensures that a rare but treatable cause of abdominal pain is not overlooked in the diagnostic workup 1, 2.