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Perforated intraperitoneal intrauterine contraceptive devices: diagnosis, management, and clinical outcomes.
J Minim Invasive Gynecol 2014 Jul-Aug; 21(4):596-601JM

Abstract

STUDY OBJECTIVE

To describe a series of intraperitoneal perforated intrauterine contraception devices (IUDs) and to discuss associated findings, methods for diagnosis, and management of this complication.

DESIGN

Retrospective review of surgical database between 1998 and 2012 (Canadian Task Force classification II-2).

SETTING

University medical center.

PATIENTS

Thirty-seven women with a perforated IUD in the intraperitoneal cavity.

MEASUREMENTS AND MAIN RESULTS

Nineteen copper IUDs (51%), 17 levonorgestrel-releasing IUDs (LNG-IUDs) (46%), and 1 Lippes loop (3%) were identified. Twenty women (54%) had abdominal pain, 16 (43%) had no symptoms, and 1 (3%) was found to have strings protruding from her anus. Twenty-six women (70%) underwent laparoscopy to remove the IUD, and 6 (16%) underwent hysteroscopy along with laparoscopy. Conversion to laparotomy was required in 4 patients (11%). Two IUDs (5%) caused full-thickness rectouterine fistulas that required laparotomy for repair. Dense adhesions were found in 21 women (57%); and of those, 15 (71%) were associated with a copper IUD. Copper IUDs were significantly more likely than LNG-IUDs to be associated with dense adhesions (p = .02).

CONCLUSIONS

Perforated IUDs can be asymptomatic or cause short-term and long-term symptoms. Long-term complications include abscess and fistula formation. Copper IUDs cause a greater inflammatory process than do LNG-IUDs. Even if asymptomatic, we advocate prompt removal of all IUDs that perforate into the peritoneal cavity once they are identified. Laparoscopic surgical removal of an intraperitoneal IUD is a safe and preferred method.

Links

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    Authors+Show Affiliations

    Kho KA
    Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: Kimberly.Kho@utsouthwestern.edu.
    Chamsy DJ
    Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.

    MeSH

    AdultDatabases, FactualFemaleHumansHysteroscopyIntrauterine Device MigrationIntrauterine DevicesIntrauterine Devices, CopperIntrauterine Devices, MedicatedLaparoscopyRectal FistulaRetrospective StudiesTissue AdhesionsUterine DiseasesUterine PerforationYoung Adult

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    24462588

    Citation

    Kho, Kimberly A., and Dina J. Chamsy. "Perforated Intraperitoneal Intrauterine Contraceptive Devices: Diagnosis, Management, and Clinical Outcomes." Journal of Minimally Invasive Gynecology, vol. 21, no. 4, 2014, pp. 596-601.
    Kho KA, Chamsy DJ. Perforated intraperitoneal intrauterine contraceptive devices: diagnosis, management, and clinical outcomes. J Minim Invasive Gynecol. 2014;21(4):596-601.
    Kho, K. A., & Chamsy, D. J. (2014). Perforated intraperitoneal intrauterine contraceptive devices: diagnosis, management, and clinical outcomes. Journal of Minimally Invasive Gynecology, 21(4), pp. 596-601. doi:10.1016/j.jmig.2013.12.123.
    Kho KA, Chamsy DJ. Perforated Intraperitoneal Intrauterine Contraceptive Devices: Diagnosis, Management, and Clinical Outcomes. J Minim Invasive Gynecol. 2014;21(4):596-601. PubMed PMID: 24462588.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Perforated intraperitoneal intrauterine contraceptive devices: diagnosis, management, and clinical outcomes. AU - Kho,Kimberly A, AU - Chamsy,Dina J, Y1 - 2014/01/21/ PY - 2013/11/19/received PY - 2013/12/30/revised PY - 2013/12/31/accepted PY - 2014/1/28/entrez PY - 2014/1/28/pubmed PY - 2015/6/9/medline KW - Intra-abdominal KW - Intraperitoneal KW - Laparoscopy KW - Missing IUD KW - Perforated SP - 596 EP - 601 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 21 IS - 4 N2 - STUDY OBJECTIVE: To describe a series of intraperitoneal perforated intrauterine contraception devices (IUDs) and to discuss associated findings, methods for diagnosis, and management of this complication. DESIGN: Retrospective review of surgical database between 1998 and 2012 (Canadian Task Force classification II-2). SETTING: University medical center. PATIENTS: Thirty-seven women with a perforated IUD in the intraperitoneal cavity. MEASUREMENTS AND MAIN RESULTS: Nineteen copper IUDs (51%), 17 levonorgestrel-releasing IUDs (LNG-IUDs) (46%), and 1 Lippes loop (3%) were identified. Twenty women (54%) had abdominal pain, 16 (43%) had no symptoms, and 1 (3%) was found to have strings protruding from her anus. Twenty-six women (70%) underwent laparoscopy to remove the IUD, and 6 (16%) underwent hysteroscopy along with laparoscopy. Conversion to laparotomy was required in 4 patients (11%). Two IUDs (5%) caused full-thickness rectouterine fistulas that required laparotomy for repair. Dense adhesions were found in 21 women (57%); and of those, 15 (71%) were associated with a copper IUD. Copper IUDs were significantly more likely than LNG-IUDs to be associated with dense adhesions (p = .02). CONCLUSIONS: Perforated IUDs can be asymptomatic or cause short-term and long-term symptoms. Long-term complications include abscess and fistula formation. Copper IUDs cause a greater inflammatory process than do LNG-IUDs. Even if asymptomatic, we advocate prompt removal of all IUDs that perforate into the peritoneal cavity once they are identified. Laparoscopic surgical removal of an intraperitoneal IUD is a safe and preferred method. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/24462588/Perforated_intraperitoneal_intrauterine_contraceptive_devices:_diagnosis_management_and_clinical_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(14)00028-4 DB - PRIME DP - Unbound Medicine ER -