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

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.

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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