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J Minim Invasive Gynecol. 2014 Jul-Aug;21(4):596-601. doi: 10.1016/j.jmig.2013.12.123. Epub 2014 Jan 21.

Perforated intraperitoneal intrauterine contraceptive devices: diagnosis, management, and clinical outcomes.

Author information

1
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: Kimberly.Kho@utsouthwestern.edu.
2
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.

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.

KEYWORDS:

Intra-abdominal; Intraperitoneal; Laparoscopy; Missing IUD; Perforated

PMID:
24462588
PMCID:
PMC6661232
DOI:
10.1016/j.jmig.2013.12.123
[Indexed for MEDLINE]
Free PMC Article

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