Laparoscopic removal of an intraperitoneal translocated intrauterine contraceptive device

Migration of an intrauterine device to the left inguinal region, the first reported case

INTRODUCTION

A large number of complications are reported with the use of IUD. Migration to inguinal region has not been mentioned in literature. We report a rare case of migrated IUD to inguinal canal.

CASE REPORT

A 25-year-old lady presented with a painfull mass in the left inguinal region. Diagnostic work up showed migrated IUD to inguinal region. Operation was done and the impacted IUD with surrounding granuloma was retrieved.

DISCUSSION

When the string of the IUD is no longer visible at the external os of the cervix, radiological scan must be performed, this should begin with a sonographic examination and plain abdominal radiography may be used to localize the IUD.

CONCLUSION

IUD Migration may occur to unusual area and perforation can be misdiagnosed as non-witnessed expulsion.

Evaluation of predisposing factors, diagnostic and treatment methods in patients with translocation of intrauterine devices

AIM

The purpose of this study was to evaluate the diagnostic methods, predisposing risk factors and surgical treatment options in patients with translocation of intrauterine devices (IUD).

MATERIAL AND METHODS

Diagnosis, predisposing factors and treatment of 34 patients with translocation of IUD was evaluated in this retrospective study.

RESULTS

Complaints of pain during insertion and history of cesarean section were present in 70.5% and 58.8% of patients, respectively. IUD-related complications were detected in 52.8% of patients. Transvaginal ultrasonography was used to detect translocation of IUD in 55.8% of cases. Laparoscopy was performed in 55.8% of patients.

CONCLUSION

There were high rates of history of cesarean section, insertion in the puerperal period and insertion by midwives in patients with translocated IUD. These may be predisposing factors for IUD translocation. The clinician who inserts the IUD should be experienced in this area and obtain sufficient information from the pelvic examination prior to insertion of the device. Gynecological examination should be conducted for a proper diagnosis of translocation of IUD. In the event that the IUD string is not visible in the gynecological examination, transvaginal ultrasonography should be performed. If the IUD is still not visible, then abdominal radiography should be performed. As soon as diagnosis of translocation of IUD has been established, surgical treatment should be planned. First treatment of choice should be laparoscopy.

Removal of intra-abdominal mislocated intrauterine devices by laparoscopy

This retrospective study was carried out on 15 patients who underwent laparoscopy for the removal of a mislocated IUD from 2003 to 2009. The mean duration of usage of an IUD was 16.1 months. The IUD was found in the Pouch of Douglas in six patients; in the posterior wall of the uterus in three patients; in the adnexa in three patients; in the omentum in two patients and it was embedded in the rectal serosa in one patient. The types of the IUDs were TCu-380A (n = 13) and Mirena(®) (n = 2). The mean laparoscopic operation time was 25 min. No major complications occurred. A second ancillary port was required in three patients. All patients were discharged within 24 h. Laparoscopic removal of the intra-abdominal IUD must be the first choice of therapy. If possible, a single ancillary port should be preferred for the removal of mislocated IUDs. We advise that surgical removal and surgical risk should be discussed with the patients, even if asymptomatic.

Uterine Perforation by an Intrauterine Contraceptive Device

An intrauterine contraceptive device (IUCD) is an effective and widely accepted method of contraception. Although complications are uncommon, an IUCD can perforate the uterus, causing serious side effects. Sonography is often the first imaging modality used when uterine perforation is clinically suspected.

Laparoscopic removal of a perforating intrauterine device mimicking chronic appendicitis

The intrauterine contraceptive device (IUD) is a common form of reversible birth control. One of the rare, but serious, complications is uterine perforation. In this paper, we report a case of a patient who underwent laparoscopy for presumed chronic appendicitis. Intraoperatively, uterine perforation by the IUD was found. The IUD was removed laparoscopically. The postoperative course was uneventful.