Laparoscopic removal of translocated intrauterine contraceptive devices

Elective surgical removal of migrated intrauterine contraceptive devices from within the peritoneal cavity: a comparison between open and laparoscopic removal

BACKGROUND

Intrauterine contraceptive devices (IUCDs) comprise the most popular form of reversible contraception. Uterine perforation is a rare but potentially serious complication associated with their use. We examined all reported cases of elective surgical removal of peritoneally migrated IUCDs, to compare laparoscopic and open approaches, and to identify beneficial surgical techniques.

DATABASE

MEDLINE and Embase were searched using the following medical subject heading terms: (IUCD or IUD or IUS or intrauterine device or intrauterine devices, copper or intrauterine devices, medicated) AND (migrated or displaced or foreign-body migration or intrauterine device migration) AND (peritoneal or peritoneal cavity). The Cochrane Library was searched using the terms IUCD, IUD, IUS, and intrauterine device. Additional studies were identified by manually searching the reference lists of the studies found through database search. Studies were included irrespective of language or publication type.

DISCUSSION

We identified 129 cases, reported in 30 studies. In the majority of cases (93.0% [120/129]), surgery was attempted laparoscopically; however 22.5% (27/120) of surgeries were converted to open operations, giving an overall rate of open surgery of 27.9% (36/129). This systematic review supports the use of laparoscopic surgery for elective removal of migrated IUCDs from the peritoneal cavity. With complications rarely reported, it is also likely the procedure could be undertaken in an outpatient setting. The use of intraoperative adjuncts (ie, cystoscopy) and the rate of conversion to open surgery are influenced by the site of the IUCD. Therefore, accurate preoperative localization of the device is advised.

Simultaneous laparoscopic cholecystectomy and removal of an intrauterine device translocated to the right subdiaphragmal region: a case report

INTRODUCTION

Intrauterine devices are often accompanied by various complications, of which the uterine perforation constitutes the most dangerous one.

CASE PRESENTATION

We present a case of a 41-year-old woman complaining of right upper quadrant pain. She had an intrauterine device inserted 12 years earlier without regular follow-up. Abdominal plain X-ray revealed the intrauterine device trans-located into the right subdiaphragmal area. Abdominal ultrasound showed gallbladder stones without any other sonographic pathologic finding. Patient underwent simultaneous laparoscopic cholecystectomy and removal of the intrauterine device from the right subdiaphragmal area.

CONCLUSION

Laparoscopy is an appropriate method for removal of intrauterine device translocated to the right subdiaphragmatic region.

324 cases of misplaced IUCD--a 5-year study

Copper-T remains the mainstay of family planning measures in developing countries but is associated with serious complications like bleeding, perforation and migration to adjacent organs or omentum. Patients with misplaced intrauterine contraceptive device (IUCD) may present with pregnancy or lost strings or may remain asymptomatic for years. In our series of 324 cases with misplaced IUCD1; in 258 (79.93%) cases copper-T was found in the uterine cavity and in 47 cases (14.51%) it was removed from cervical canal. In only 18 cases (5.56%), it was translocated and of these 66.67% were inserted at primary health centres. Laparoscopic retrieval was successful in 61.11% cases. Endoscopy thus helps in the localization and retrieval of misplaced IUCDs. A regular follow up of IUCDs for visible threads would help in earlier detection of misplaced IUCDs. Proper training of paramedical staff is mandatory in developing countries to provide safe and better family planning services.

Role of endoscopy in retrieval of misplaced intrauterine device

We report a series of 45 patients with misplaced intrauterine devices (30 extrauterine and 15 intrauterine). Only those patients with intrauterine misplacements in whom conventional blind removal was not possible were included in the study. All of the 15 misplaced intrauterine devices could be removed hysteroscopically; 22 of the 30 extrauterine misplaced devices (73%) could be removed laparoscopically. One patient required both laparoscopy and hysteroscopy. Only 7 (15.5%) of 45 patients required laparotomy for safe removal of misplaced devices. Considerable comfort and minimal hospital stay associated with endoscopic procedures should offer these as the first line attempt to remove a misplaced intrauterine or extrauterine translocated device.