Laparoscopic removal of an intra-abdominal intrauterine device: case and systematic review

Gill, Richdeep S.; Mok, Dereck; Hudson, Matthew; Shi, Xinzhe; Birch, Daniel W.; Karmali, Shahzeer

doi:10.1016/j.contraception.2011.04.015

Cited by 76 publications

(112 citation statements)

References 16 publications

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“…We found that uterine perforation with modern devices is rarely dangerous, as reported in recent publications (van Grootheest et al, 2011;Gill et al, 2012). The majority of women experienced symptoms resulting in a consultation.…”

Section: Discussionsupporting

confidence: 60%

“…All adhesions, either IUD-associated or clearly non-related, were local and occurred more often with a Cu-IUD. Although adhesions were found in 30% of the laparoscopies, none led to laparotomy, unlike in the large case series reviewed by Gill et al (2012), where adhesions were a common cause of laparotomy. Similarly, we found no visceral complications caused by the perforating IUDs/IUSs and no correlation between symptoms and intra-abdominal adhesions in surgery.…”

Section: Discussionmentioning

confidence: 91%

“…Case reports show that misplaced IUDs have caused bowel perforations and adhesions leading to peritonitis (Zakin et al, 1981;Gill et al, 2012). However, as many investigators have found minimal or no adhesions with both modern non-irritating polyethylene-framed Cu-IUDs and the LNG-IUS, the need to remove intra-abdominal IUDs in asymptomatic cases has repeatedly been questioned (Adoni and Ben Chetrit, 1991;Markovitch et al, 2002;Haimov-Kohman et al, 2003b).…”

Section: Introductionmentioning

confidence: 99%

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Uterine perforation caused by intrauterine devices: clinical course and treatment

Kaislasuo

Suhonen²,

Gissler

et al. 2013

Human Reproduction

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summary answer: Symptoms are mostly mild and 30% of women are asymptomatic. Surgical findings are mainly minimal; no visceral complications were found in this study. However, adhesions as well as pregnancies seem to be more common among women using Cu-IUDs. what is known already: Prior studies and case reports have suggested that uterine perforation by modern IUDs/IUSs is rarely serious. main results and the role of chance: The majority of patients (n ¼ 53; 71%) had mild symptoms of abnormal bleeding or abdominal pain or both, in combination with missing IUD/IUS threads. Asymptomatic patients (n ¼ 22; 29%) were examined because of missing threads or pregnancy. Failure to remove the IUD/IUS by pulling visible threads was the reason for referral in seven women (9%) requesting removal of the device. Eleven women (15%) were pregnant. Misplaced IUDs/IUSs were localized by a combination of vaginal ultrasonography (US) and X-ray, hysteroscopy or curettage. Only after this were patients treated by means of laparoscopy. The majority (n ¼ 44; 65%) of the 68 intra-abdominal devices were located in the omentum, the remaining 24 (35%) around the uterus. Partial perforation or myometrial embedding was diagnosed in all seven cases (9%) with visible threads, but unsuccessful removal by pulling. During laparoscopy, filmy adhesions were found in 21 patients (30%). Pregnancy (33 versus 7%, P ¼ 0.009) and intra-abdominal adhesions (58 versus 20%, P ¼ 0.002) were significantly more common in the Cu-IUD group. Infections were rare; one non-specific acute abdominal infection, later found to be unrelated to the IUD, led to laparoscopy and in four cases the IUD was surrounded by pus, but there were no symptoms of infection.limitations, reasons for caution: The study setting revealed only surgically treated symptomatic patients and asymptomatic women attending regular follow-up. Women not treated, but only followed or not attending follow-up, were not identified, excluding the possibility to analyse missed undiagnosed perforations, or conservative follow-up as a treatment option.wider implications of the findings: As surgical findings are minimal, asymptomatic women may need no treatment at all.An alternative form of contraception is, however, important as pregnancies do occur. If a woman plans a pregnancy, a misplaced LNG-IUS should be removed, as it may act as a contraceptive. study funding/competing interest(s): Helsinki University Central Hospital research funds. O.H. has lectured and designed educational events with Bayer AG and MSD, and serves occasionally on scientific advisory boards for these companies. S.S. has

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Uterine perforation caused by intrauterine devices: clinical course and treatment

Kaislasuo

Suhonen²,

Gissler

et al. 2013

Human Reproduction

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“…Laparoscopy can be used as a first-line treatment even in the presence of Badr et al J Clin Gynecol Obstet. 2017;6(3-4):75-78 adhesions or visceral injury [14]. In two out of the seven cases reviewed, laparoscopy was used to remove the IUD but the chronicity of migration and the tubal infection resulted in tubal sacrifice in both patients.…”

Section: Discussionmentioning

confidence: 99%

Tubal Migration of Intrauterine Device: A Report of a Rare Case of Trauma-Induced Migration Leading to Acute Abdomen

Badr¹,

Cheikh²,

Hassan³

et al. 2017

J Clin Gynecol Obstet

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Intrauterine devices (IUDs) are the most commonly used reversible contraceptive methods. They are a highly effective and safe tool of contraception but might carry some uncommon complications including device migration. Trauma-induced trans-tubal migration has not been reported before. We encountered a 26-year-old woman who presented to the emergency department (ED) with left iliac fossa pain, 1 day following a fall-down trauma. She had a history of uneventful IUD insertion 3 months prior to presentation. In the ED, a standing KUB showed an extra-uterine intra-abdominal IUD. At laparoscopy, the IUD was found protruding through the isthmic part of the fallopian tube. Trauma to patients wearing IUDs should prompt fellow gynecologists to check the location of the device within 24 -48 h. Recognition of this rare yet serious complication can be of benefit in the differential diagnosis of patients presenting to the ED with acute abdomen.

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“…Case reports of uterine perforation have become increasingly common, likely because of the growing popularity of IUD use. Perforation may be asymptomatic or may cause pain, abnormal bleeding, bowel or bladder perforation, obstruction or fistula formation [2]. Here, we report a case of an IUD migrating through the uterus into the peritoneal cavity and subsequently invading into the sigmoid colon by using laparotomic techniques.…”

Section: Introductionmentioning

confidence: 99%

Intrauterine Contraceptive Device Migration to the Sigmoid Colon: A Case Report

Özdemir¹,

Sarı²,

Sen³

et al. 2015

Med-Science

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Laparoscopic removal of an intra-abdominal intrauterine device: case and systematic review

Cited by 76 publications

References 16 publications

Uterine perforation caused by intrauterine devices: clinical course and treatment

Uterine perforation caused by intrauterine devices: clinical course and treatment

Tubal Migration of Intrauterine Device: A Report of a Rare Case of Trauma-Induced Migration Leading to Acute Abdomen

Intrauterine Contraceptive Device Migration to the Sigmoid Colon: A Case Report

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