Dual Implanon®️ Device Removal in an Indonesian Female Patient: A Case Report

   

Nirmala Dewi AP Subramoniam¹, Aisah Binti Haji Mahit¹, Kris Ke Shyang See^2*, Miew Leng Khoo², Kyle Khang Lyn Tan¹, Wai Hong Cheang¹, Amarpreet Kaur Sarjit Singh¹, Scott Low Jun Kuang¹, Kalichandren Arumugam¹, Nirmala Dewi AP Subramoniam¹, Agnes Mun Ying Tan¹, Romel Mario Soyza¹, Nik Nassyiradina Putri Binti Nik Ahmat¹, Dhevisri Vasu¹, Qistina Letisya Binti Johari¹, Yin Ying Lim¹ and Ananyaa Sreekumar¹

Citation: Subramoniam NDAP, Mahit ABH, See KKS, Khoo ML, Tan KKL, et al. Dual Implanon®️ Device Removal in an Indonesian Female Patient: A Case Report. Genesis J Gynaecol Obstet. 1(1):1-3.

Received: June  16, 2025 | Published: July 26, 2025

Copyright^© 2025 genesis pub by Subramoniam NDAP. CC BY-NC-ND 4.0 DEED. This is an open-access article distributedunder the terms of the Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License.,This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.

Abstract

This case report presents a rare but instructive scenario involving the removal of two subdermal Implanon®️ devices from a 34-year-old Indonesian female in a primary care setting without imaging support. The case underscores the importance of clinical judgment, accurate palpation, and comprehensive patient counselling in managing contraceptive devices, especially when imaging modalities are unavailable.

Keywords

Dual Implanon; Palpation; Contraceptice devices; Irregular menstrual

Introduction

Implanon ® ️ is a long-acting reversible contraceptive (LARC) consisting of a single rod containing 68 mg of etonogestrel. It is designed for subdermal insertion and provides contraception for up to three years. Errors during insertion or follow-up, such as failure to remove an expired implant before reinsertion, may lead to unintentional dual implantation, posing diagnostic and management challenges.

In many low-resource settings, clinicians must rely solely on history-taking and palpation due to limited access to ultrasound or imaging.

Case Presentation

Patient details

A 34-year-old Indonesian female presented to our clinic with complaints of irregular menstrual spotting and mild discomfort in the upper left arm. She reported receiving her first Implanon ® ️ three and half years ago at a rural clinic in Medan, Indonesia.

Examination

Palpation of the inner upper arm revealed two firm, linear, mobile subdermal rods, approximately 2 cm apart. There were no signs of infection, inflammation, or fibrosis. No imaging or ultrasound was available onsite, and the patient declined referral for radiological confirmation due to cost and travel burden.

Procedure

Under aseptic conditions, and after local infiltration with 1% lignocaine, a small skin incision was made directly over the palpated implants. Incidentally, we notice there was a presence of a second implant, hence the incision was extended. Both rods were successfully removed with blunt dissection and forceps. Each was intact and measured approximately 4 cm, consistent with standard Implanon®️ devices. The wounds were closed with adhesive strips and dressed.

Outcome and follow-up

The patient tolerated the procedure well and was discharged on the same day. She reported no complications. Wound healing was satisfactory. She opted for barrier contraception and was counselled on future contraceptive choices.

Discussion

This case demonstrates the potential pitfalls of LARC programs when documentation and follow-up are inadequate. Failure to remove expired implants before reinsertion can lead to cumulative hormonal exposure, irregular bleeding, and patient confusion.

Although imaging is typically used to locate implants, especially when non-palpable or migrated this case highlights that clinical palpation, when performed skillfully, can suffice in straightforward scenarios. This is particularly relevant in low-resource settings.

Cases of retained or duplicate implants are increasingly reported globally and indicate a need for strengthened provider training and better contraceptive record systems.

Moreover, evidence suggests that subdermal implant complications are more likely in the absence of standardised protocols or skilled insertion providers. Clinical management should be guided by WHO and national guidelines for contraceptive use

Conclusion

This case demonstrates that the safe removal of multiple contraceptive implants without imaging is achievable through proper clinical technique and thorough history-taking. It further emphasises the need for structured follow-up, reliable documentation, and enhanced provider training to prevent similar occurrences. In resource-constrained environments, strong clinical skills remain essential to delivering quality reproductive care.

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