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Toh WL, Lim WW, Tan WKA, Lim SKJ. An Unusual, Delayed Presentation of a Migrated Intrauterine Contraceptive Device Into the Rectosigmoid Colon. Cureus 2023; 15:e42851. [PMID: 37664308 PMCID: PMC10473236 DOI: 10.7759/cureus.42851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
The current literature suggests that serious complications after intrauterine contraceptive device (IUCD) insertion are rare. We present a rare case of a migrated IUCD into the rectosigmoid colon. A 33-year-old woman (parity one) presented to the emergency department with a three-day history of flank pain, upper urinary tract infection symptoms, and a low-grade fever. Differentials initially included renal colic or pyelonephritis. However, subsequent computed tomography of the kidneys, ureters, and bladder (CT-KUB) and magnetic resonance imaging of the pelvis (MRI-pelvis) showed a migrated IUCD posterior to the uterine body, with both ends closely abutting onto the adjacent proximal rectum. During further history-taking, she reported a past surgical history of an emergency caesarean section five years ago and the insertion of a copper-IUCD six weeks postnatally. She was subsequently referred to the gynaecologists. In view of the involvement of the bowels, the colorectal surgeons were consulted, and the patient was managed by a multidisciplinary team. The patient subsequently underwent diagnostic hysteroscopy, flexible sigmoidoscopy, diagnostic laparoscopy, removal of impacted IUCD, and repair of the rectum. Intraoperatively, her hysteroscopy noted a normal uterus with an intact cavity. Flexible sigmoidoscopy noted the horizontal arm of the IUCD abutting into the lumen of the rectosigmoid region; however, attempted removal with traction was unsuccessful. A partial rectotomy was done eventually to remove the IUCD. Migration of an IUCD is rare, with uterine perforation rates ranging from 0.04% to 0.2%. Albeit a rare complication, this case highlights the need for clinicians to be cognizant of complications arising from IUCD insertion, as symptoms are often non-specific and mild. This case also highlights the importance of a multidisciplinary discussion in the management of a migrated IUCD, which may include gynaecologists, colorectal surgeons, radiologists, and more. Many innovative ways were also discussed regarding the assessment of it, which includes preoperative imaging or endoscopic evaluation. Novel methods of removal of migrated IUCD in the rectosigmoid colon have also been proposed, including manual traction, proctoscopy, rigid sigmoidoscopy, and removal via a snare. They provide an alternative to the traditional diagnostic laparoscopy or laparotomy, thus reducing the need for general anaesthesia or operative intervention. Looking forward, long-term studies can be done to evaluate the need for intervention for asymptomatic patients where the risk of surgery may outweigh the benefits.
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Affiliation(s)
- Wuen Lynn Toh
- Department of Obstetrics and Gynaecology, Singapore General Hospital/ SingHealth, Singapore, SGP
| | - Whui Whui Lim
- Department of Obstetrics and Gynaecology, Singapore General Hospital/ SingHealth, Singapore, SGP
| | - Wei Keat Andy Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital/ SingHealth, Singapore, SGP
| | - Shau Khng Jason Lim
- Department of Obstetrics and Gynaecology, Singapore General Hospital/ SingHealth, Singapore, SGP
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An Y, Liu C, Mao F, Yang G, Mao G. Intrauterine device found in an ovarian tumor: A case report. Medicine (Baltimore) 2020; 99:e22825. [PMID: 33080762 PMCID: PMC7571936 DOI: 10.1097/md.0000000000022825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Intrauterine devices (IUDs) are one of the most common and effective methods of contraception worldwide. Migration of an IUD to an extrauterine site is a rare complication. The aim of this study was to report an extremely rare case in which an IUD was found in an ovarian tumor. PATIENT CONCERNS A 63-year-old Chinese woman presented with vaginal bleeding and lower abdominal pain during hospitalization due to pneumonia. Preoperative imaging showed bilateral cystic masses in the adnexal region, and ring hyperdensity was found in the right ovarian mass. Endometrial thickening and multiple uterine leiomyomas were found on ultrasonography. Hysteroscopy showed partial septate uterus and a small endometrial polyp. DIAGNOSIS Bilateral ovarian cystadenomas with perforation of the IUD into the right ovarian tumor were considered based on preoperative imaging and the patient's medical history. Furthermore, early endometrial carcinoma was suspected. INTERVENTIONS The patient underwent hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. A stainless steel ring IUD was confirmed within the right ovarian tumor during the operation. OUTCOMES The pathology results demonstrated bilateral ovarian serous cystadenofibromas with focal epithelial proliferation and endometrial atypical hyperplasia with malignant transformation. The patient has been followed up for 7 months, and there has been no recurrence at present. LESSONS The presence of an IUD within an ovarian tumor is extremely rare. This is the second reported case in the English literature describing an extrauterine IUD within an ovarian tumor. The correlation between ovarian cancer tumorigenesis and IUD translocation is unclear and requires further investigation.
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Chi E, Rosenfeld D, Sokol TP. Laparoscopic Removal of an Intrauterine Device Perforating the Sigmoid Colon: A Case Report and Review of the Literature. Am Surg 2020. [DOI: 10.1177/000313480507101214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of a translocated intrauterine device (IUD) embedded within the colon wall. Endoscopic tattooing and laparoscopy was used to identify the colonic site and facilitate extraction by colonic resection. A review of the literature and discussion of laparoscopic management of this complication is presented.
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Affiliation(s)
- Esmond Chi
- Division of Colorectal Surgery, Loma-Linda Medical Center, and
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4
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Rowlands S, Oloto E, Horwell DH. Intrauterine devices and risk of uterine perforation: current perspectives. Open Access J Contracept 2016; 7:19-32. [PMID: 29386934 PMCID: PMC5683155 DOI: 10.2147/oajc.s85546] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Uterine perforation is an uncommon complication of intrauterine device insertion, with an incidence of one in 1,000 insertions. Perforation may be complete, with the device totally in the abdominal cavity, or partial, with the device to varying degrees within the uterine wall. Some studies show a positive association between lactation and perforation, but a causal relationship has not been established. Very rarely, a device may perforate into bowel or the urinary tract. Perforated intrauterine devices can generally be removed successfully at laparoscopy.
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Affiliation(s)
- Sam Rowlands
- Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, Bournemouth University, Dorset, UK
| | - Emeka Oloto
- Staffordshire and Stoke on Trent Partnership NHS Trust, Leicester, UK
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Agacayak E, Tunc SY, Icen MS, Oguz A, Ozler A, Turgut A, Basaranoglu S. Evaluation of predisposing factors, diagnostic and treatment methods in patients with translocation of intrauterine devices. J Obstet Gynaecol Res 2014; 41:735-41. [PMID: 25421253 DOI: 10.1111/jog.12620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Abstract
AIM The purpose of this study was to evaluate the diagnostic methods, predisposing risk factors and surgical treatment options in patients with translocation of intrauterine devices (IUD). MATERIAL AND METHODS Diagnosis, predisposing factors and treatment of 34 patients with translocation of IUD was evaluated in this retrospective study. RESULTS Complaints of pain during insertion and history of cesarean section were present in 70.5% and 58.8% of patients, respectively. IUD-related complications were detected in 52.8% of patients. Transvaginal ultrasonography was used to detect translocation of IUD in 55.8% of cases. Laparoscopy was performed in 55.8% of patients. CONCLUSION There were high rates of history of cesarean section, insertion in the puerperal period and insertion by midwives in patients with translocated IUD. These may be predisposing factors for IUD translocation. The clinician who inserts the IUD should be experienced in this area and obtain sufficient information from the pelvic examination prior to insertion of the device. Gynecological examination should be conducted for a proper diagnosis of translocation of IUD. In the event that the IUD string is not visible in the gynecological examination, transvaginal ultrasonography should be performed. If the IUD is still not visible, then abdominal radiography should be performed. As soon as diagnosis of translocation of IUD has been established, surgical treatment should be planned. First treatment of choice should be laparoscopy.
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Affiliation(s)
- Elif Agacayak
- Department of Obstetrics and Gynecology, Dicle University School of Medicine, Diyarbakir, Turkey
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6
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Ertopcu K, Nayki C, Ulug P, Nayki U, Gultekin E, Donmez A, Yildirim Y. Surgical removal of intra-abdominal intrauterine devices at one center in a 20-year period. Int J Gynaecol Obstet 2014; 128:10-3. [DOI: 10.1016/j.ijgo.2014.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 07/17/2014] [Accepted: 08/29/2014] [Indexed: 12/31/2022]
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7
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Weerasekera A, Wijesinghe P, Nugaduwa N. Sigmoid colocolic fistula caused by intrauterine device migration: a case report. J Med Case Rep 2014; 8:81. [PMID: 24594141 PMCID: PMC3946035 DOI: 10.1186/1752-1947-8-81] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/06/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction The intrauterine device is a form of contraception with a long duration of action and few systemic side effects. Migration into the abdominal cavity may occur early or years after insertion giving rise to bowel obstruction, perforation, ischemia, mesenteric injury, strictures or fistulae. Colocolic fistula formation is a rare but serious complication of intrauterine device migration, which may lead to difficulties in diagnosis and device retrieval. Case presentation We report the case of a 29-year-old Sri Lankan woman who became pregnant 5 years after intrauterine device insertion. The device could not be located during pregnancy. She was asymptomatic and defaulted follow up during the antenatal period. She had an uncomplicated vaginal delivery. A subsequent laparotomy for device retrieval failed due to technical difficulties. A repeat laparotomy identified a sigmoid colocolic fistula with adhesions to the fallopian tube. The device was removed and colonic defects primarily closed following which the patient made an uneventful recovery. Conclusions All translocated intrauterine devices should be removed regardless of type and location. This case illustrates that they may cause complex bowel lesions leading to serious technical difficulties during retrieval. With the increasing use of minimally invasive approaches for intrauterine device retrieval, a low threshold for open surgery in complicated cases is advocated.
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8
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Şengül Ö, Dilbaz B, Kavak D, Dede S, Yerebasmaz N, Altinbaş Ş. Surgical management of extrauterine mislocated intrauterine contraceptive devices and related risks. J OBSTET GYNAECOL 2013; 34:70-3. [DOI: 10.3109/01443615.2013.831047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Boortz HE, Margolis DJA, Ragavendra N, Patel MK, Kadell BM. Migration of intrauterine devices: radiologic findings and implications for patient care. Radiographics 2012; 32:335-52. [PMID: 22411936 DOI: 10.1148/rg.322115068] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Intrauterine devices (IUDs) are a commonly used form of contraception worldwide. However, migration of the IUD from its normal position in the uterine fundus is a frequently encountered complication, varying from uterine expulsion to displacement into the endometrial canal to uterine perforation. Different sites of IUD translocation vary in terms of their clinical significance and subsequent management, and the urgency of communicating IUD migration to the clinician is likewise variable. Expulsion or intrauterine displacement of the IUD leads to decreased contraceptive efficacy and should be clearly communicated, since it warrants IUD replacement to prevent unplanned pregnancy. Embedment of the IUD into the myometrium can usually be managed in the outpatient clinical setting but occasionally requires hysteroscopic removal. Complete uterine perforation, in which the IUD is partially or completely within the peritoneal cavity, requires surgical management, and timely and direct communication with the clinician is essential in such cases. Careful evaluation for intraabdominal complications is also important, since they may warrant urgent or emergent surgical intervention. The radiologist plays an important role in the diagnosis of IUD migration and should be familiar with its appearance at multiple imaging modalities.
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Affiliation(s)
- Hillary E Boortz
- Department of Radiology, University of California at Los Angeles, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
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10
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Chen PH, Lee SL, Chang CY, Chang CC. Pneumoperitoneum caused by perforation of pyometra associated with a lost intrauterine device and perforated malignancy of the sigmoid colon. Taiwan J Obstet Gynecol 2011; 50:124-5. [PMID: 21482392 DOI: 10.1016/j.tjog.2009.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2009] [Indexed: 12/01/2022] Open
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11
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Park JM, Lee CS, Kim MS, Kim DY, Kim CY, Lim YB, Lee YK, Park DE, Lee DH. Penetration of the descending colon by a migrating intrauterine contraceptive device. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2010; 26:433-6. [PMID: 21221246 PMCID: PMC3017981 DOI: 10.3393/jksc.2010.26.6.433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 09/23/2010] [Indexed: 10/30/2022]
Abstract
Foreign bodies in the gastrointestinal tract often cause serious complications, such as perforation, obstruction, abscess formation, or hemorrhage. This is a case in which a patient visited our hospital and complained of a vague lower abdominal pain that had been present for three months. She had an intrauterine device (IUD) inserted five years earlier. The abdominal X-ray, computed tomography and colonoscopy revealed that the IUD had penetrated into the descending colon. We tried to remove the IUD by colonoscopy but failed due to pain, so we removed the IUD surgically. Thus, we report a case in which a previously inserted IUD had penetrated into the descending colon and was surgically removed. We also present a brief review of the literature.
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Affiliation(s)
- Jung Min Park
- Department of Internal Medicine, Good Gang-An Hospital, Busan, Korea
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12
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Lee JE, Park KS, Kim ES, Cho KB, Shin SJ, Cho CH, Cha SD. Removal of a lost intrauterine device by colonoscopy after a successful full-term delivery (with video). Gastrointest Endosc 2010; 72:898-900. [PMID: 20537636 DOI: 10.1016/j.gie.2010.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 01/20/2010] [Indexed: 12/10/2022]
Affiliation(s)
- Jeong Eun Lee
- Department of Gastroenterology, Keimyung University School of Medicine, Daegu, Korea
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13
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Meshikhes AWN, El-Tair M, Al-Zahir AA. Laparoscopic removal of a migrated intrauterine contraceptive device. J OBSTET GYNAECOL 2010; 30:317-9. [PMID: 20373946 DOI: 10.3109/01443610903585200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A-W N Meshikhes
- Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
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14
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Miranda L, Settembre A, Capasso P, Cuccurullo D, Pisaniello D, Corcione F. Laparoscopic removal of an intraperitoneal translocated intrauterine contraceptive device. EUR J CONTRACEP REPR 2009. [DOI: 10.1080/ejc.8.2.122.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Ingec M, Kumtepe Y, Kadanali S, Ozdiller O. A rare case of ileal embedding by an intrauterine device. EUR J CONTRACEP REPR 2009; 10:29-31. [PMID: 16036296 DOI: 10.1080/13625180500035082] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ileal penetration by a copper-bearing intrauterine device (IUD) is a rare but serious potential complication. This paper reports the case of a 30-year-old gravida 4 para 3 woman with ileal embedding by an IUD. Laparoscopy was performed on the patient 4 months after the insertion of the IUD. When the tail of the IUD was seen during laparoscopy protruding outside the small bowel, the device was removed through a 1-cm incision in the ileum by laparotomy. This report demonstrates a rare case of ileal embedding of an IUD.
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Affiliation(s)
- M Ingec
- Sara Hatun Dogumevi, Elazig, Turkey
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16
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Verma U, Verma N. Ovarian embedding of a transmigrated intrauterine device: a case report and literature review. Arch Gynecol Obstet 2008; 280:275-8. [DOI: 10.1007/s00404-008-0882-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
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17
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Sentilhes L, Lefebvre-Lacoeuille C, Poilblanc M, Descamps P. Incidental finding of an intrauterine device in the sigmoid colon. EUR J CONTRACEP REPR 2008; 13:212-4. [PMID: 18465486 DOI: 10.1080/13625180801892868] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Translocation of an intrauterine device (IUD) to the sigmoid colon lumen is an extremely rare presentation of an ectopic IUD that usually results in fever and gastrointestinal symptoms. We report the exceptional case of an asymptomatic IUD translocation to the sigmoid colon lumen secondary to uterine perforation. CASE REPORT A CT-scan was carried out during the follow-up of a 53-year-old woman with a metastatic epidermoid carcinoma of the tongue evolving over the previous eight years. It incidentally revealed the presence of an IUD in the sigmoid colon lumen. The patient being completely asymptomatic and at the terminal stage of her disease, removal of the device by means of a surgical or endoscopic procedure was not attempted. The patient died four months later due to lung cancer; during that period of time the IUD located in the colon remained asymptomatic. CONCLUSION Asymptomatic migration of IUD to the sigmoid colon lumen can occur. Except when the patient's condition does not allow it, as in the case reported, removal of the IUD is indicated because of the risk of fistula formation and colon perforation with a high ensuing morbidity. This case report highlights the need for follow-up of patients wearing an IUD.
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Affiliation(s)
- Loïc Sentilhes
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France.
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18
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Bartalena T, Pascali E, Rinaldi MF, Marasco R, Bassi F, Alboni C, Gavelli G. Transmigrated intrauterine device discovered 17 years after its insertion. ACTA ACUST UNITED AC 2007; 51 Suppl:B284-6. [DOI: 10.1111/j.1440-1673.2007.01760.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Levsky JM, Herskovits M. Incidental detection of a transmigrated intrauterine device. Emerg Radiol 2005; 11:312-4. [PMID: 16133630 DOI: 10.1007/s10140-005-0421-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2005] [Accepted: 02/24/2005] [Indexed: 10/25/2022]
Abstract
The intrauterine device (IUD) is among the most effective forms of birth control available, with important advantages over other methods of contraception. The most striking adverse event associated with IUD use is uterine perforation and migration of the device. Contrary to what one might assume, perforation is often silent and the wayward device is either detected after further sequellae or found incidentally by imaging. The radiologist should be aware of the natural course, presentations, diagnostic evaluation and treatment (if any) for this misplaced foreign body.
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Affiliation(s)
- Jeffrey M Levsky
- Department of Radiology, Flushing Hospital Medical Center, 4500 Parsons Blvd, Flushing, NY 11355, USA.
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20
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Güngör M, Sönmezer M, Atabekoglu C, Ortaç F. Laparoscopic Management of a Translocated Intrauterine Device Perforating the Bowel. ACTA ACUST UNITED AC 2003; 10:539-41. [PMID: 14738645 DOI: 10.1016/s1074-3804(05)60163-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A woman underwent operative laparoscopy to manage a dislocated intrauterine device that perforated her bowel. The surgical procedure was uncomplicated, and postoperative recovery was uneventful.
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Affiliation(s)
- Mete Güngör
- Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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21
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Markovitch O, Klein Z, Gidoni Y, Holzinger M, Beyth Y. Extrauterine mislocated IUD: is surgical removal mandatory? Contraception 2002; 66:105-8. [PMID: 12204783 DOI: 10.1016/s0010-7824(02)00327-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The incidence of intrauterine device perforation is 0.87 per 1000 insertions. An intrauterine device (IUD) may perforate through the uterine wall into the pelvic or abdominal cavity or into adjacent organs. The accepted treatment for displaced IUDs is surgical removal because of the putative risk of adhesion formation or of damage to the intestine or urinary bladder. The purpose of this article is to present three cases of IUD perforation where surgical removal may not have been necessary. In all three cases, the IUD was removed by laparoscopy. No adhesions were found in any of the patients. Criteria for the surgical removal of a displaced IUD, as a result of uterine perforation, should be re-evaluated. Whilst surgical procedures to remove a misplaced IUD must be performed on symptomatic patients, asymptomatic patients, under certain circumstances, may benefit from conservative management.
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Affiliation(s)
- Ofer Markovitch
- Department of Obstetrics and Gynecology, Sapir Medical Center, Kfar-Saba, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.
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22
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Chen CP, Hsu TC, Wang W. Ileal penetration by a Multiload-Cu 375 intrauterine contraceptive device. A case report with review of the literature. Contraception 1998; 58:295-304. [PMID: 9883385 DOI: 10.1016/s0010-7824(98)00116-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A case of a 28-year-old gravida 3 para 2 woman with an ileal penetration by an intrauterine device (IUD) is reported. Four weeks following insertion of a Multiload-Cu 375, the woman underwent laparotomy due to persistent vague abdominal pain and translocation of the IUD. The device had perforated the fundal uterine wall and the two flexible side arms and the copper-bearing rod had completely eroded into the wall of the ileum with only the strings protruding outside the small bowel mesentery. Resection of an ileal segment with end-to-end anastomosis was performed. The woman made an uneventful recovery. It appears that a translocated Multiload-Cu 375 IUD body can penetrate and be entirely embedded within the bowel wall as early as 4 weeks following translocation. This report documents the shortest interval between insertion and proven bowel injury by an IUD.
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Affiliation(s)
- C P Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Republic of China, Taiwan
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