Challenging removal of retained laminaria fragment

Background: Laminaria is a hydroscopic cervical dilator used routinely in various obstetrical and gynecological procedures. Complications of laminaria use are rare, but include infection, anaphylaxis, retention, and fragmentation. Described herein are two cases of challenging laminaria removal. Cases: In the first case, a 36-year-old female was evaluated for infertility. A hysterosalpingogram was attempted but was unsuccessful due to cervical stenosis. A laminaria tent was placed to dilate the cervix. On removal, only a 2.5-cm laminaria fragment was retrieved, while the rest remained in the cervical canal. The fragment was visualized using transvaginal sonography. Forceps were inserted into the endocervical canal to break the scar tissue and retrieve the remaining laminaria. In the second case, a 28-year-old female was admitted for elective termination of pregnancy. The laminaria broke during attempts to retrieve it. The fragment was visualized via hysteroscopy, bifurcated with a resectoscope to ease evacuation, and retrieved from the uterine cavity via suction curette. Conclusions: Our cases involved two rare complications associated with laminaria use. Given the successful management of these cases, consideration should be given to the use of sonography or hysteroscopy for visualization of retained laminaria segments and the use of forceps or a resectoscope plus suction for retrieval. (J GYNECOL SURG 28:443)