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Dislocated intrauterine devices: clinical presentations, diagnosis and management: The European Journal of Contraception & Reproductive Health Care: Vol 26, No 2


Abstract

Objective

Intrauterine devices (IUDs) are globally one of the most popular methods of contraception. Uterine perforation is one of the most significant complications of IUD use and commonly occurs at the time of IUD insertion rather than presenting as delayed migration. This paper reports a series of 13 cases of displaced IUDs requiring retrieval by laparoscopy or laparotomy. All the IUDs were copper bearing and most perforations occurred immediately after IUD insertion.

Cases

In two patients with sigmoid colon injury and IUD penetration of the appendix, laparoscopic management had failed and laparotomy was necessary owing to severe obliteration of the pelvic cavity. In one patient laparotomy was the preferred surgical approach owing to acute bowel perforation. In the remaining patients, the displaced devices were successfully removed by laparoscopy.

Conclusion

Uterine perforation and IUD migration to the organs in the abdominopelvic cavity are serious complications of IUD insertion and can be successfully managed by laparoscopy, or by laparotomy in the presence of severe pelvic adhesions or unexpected complications.

摘要

目的:宫内节育器是世界上最流行的避孕方法之一。子宫穿孔是使用宫内节育器最重要的并发症之一, 通常发生在放置宫内节育器时, 而不是表现为延迟移位。本研究报道了13例宫内节育器移位需行腹腔镜或开腹取器病例。所有宫内节育器均为含铜宫内节育器, 大多数穿孔发生在放置宫内节育器后。

病例:在2例乙状结肠损伤和宫内节育器穿透阑尾的患者中, 由于盆腔严重粘连, 腹腔镜治疗失败, 需转开腹手术。其中一例患者因急性肠穿孔, 首选经腹手术。另一例患者通过腹腔镜手术成功地移除了移位的宫内节育器。

结论:子宫穿孔和宫内节育器移位至腹腔脏器是放置宫内节育器的严重并发症, 可通过腹腔镜手术成功治疗处理, 或在出现严重盆腔粘连或发生难以预料的并发症时通过经腹手术成功处理。

Acknowledgements

Dr Simin Taghavi (Department of Obstetrics and Gynaecology, Tabriz University of Medical Sciences) is especially thanked and appreciated for playing an important role in referring and managing the study participants. We also thank Dr Ali Montazeri (Population Health Research Group, Health Metrics Research Centre, and Iranian Institute for Health Sciences Research of Tehran University of Medical Sciences) for his help in the final editing of this article.

Disclosure statement

The authors declare that there is no conflict of interest associated with this manuscript.



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