Management of translocated and incarcerated intrauterine contraceptive devices

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.

Simultaneous laparoscopic cholecystectomy and removal of an intrauterine device translocated to the right subdiaphragmal region: a case report

INTRODUCTION

Intrauterine devices are often accompanied by various complications, of which the uterine perforation constitutes the most dangerous one.

CASE PRESENTATION

We present a case of a 41-year-old woman complaining of right upper quadrant pain. She had an intrauterine device inserted 12 years earlier without regular follow-up. Abdominal plain X-ray revealed the intrauterine device trans-located into the right subdiaphragmal area. Abdominal ultrasound showed gallbladder stones without any other sonographic pathologic finding. Patient underwent simultaneous laparoscopic cholecystectomy and removal of the intrauterine device from the right subdiaphragmal area.

CONCLUSION

Laparoscopy is an appropriate method for removal of intrauterine device translocated to the right subdiaphragmatic region.

Foreign body granuloma in the anterior abdominal wall mimicking an acute appendicular lump and induced by a translocated copper-T intrauterine contraceptive device: a case report

Introduction

Intrauterine contraceptive devices may at times perforate and migrate to adjacent organs. Such uterine perforation usually passes unnoticed with development of potentially serious complications.

Case presentation

A 25-year-old woman of North Indian origin presented with an acute tender lump in the right iliac fossa. The lump was initially thought to be an appendicular lump and treated conservatively. Resolution of the lump was incomplete. On exploratory laparotomy, a hard suspicious mass was found in the anterior abdominal wall of the right iliac fossa. Wide excision and bisection of the mass revealed a copper-T embedded inside. Examination of the uterus did not show any evidence of perforation. The next day, the patient gave a history of past copper-T Intrauterine contraceptive device insertion.

Conclusions

Copper-T insertion is one of the simplest contraceptive methods but its neglect with inadequate follow-up may lead to uterine perforation and extra-uterine migration. Regular self-examination for the "threads" supplemented with abdominal X-ray and/or ultrasound in the follow-up may detect copper-T migration early. To the best of our knowledge, this is the first report of intrauterine contraceptive device migration to the anterior abdominal wall of the right iliac fossa.

Role of endoscopy in retrieval of misplaced intrauterine device

We report a series of 45 patients with misplaced intrauterine devices (30 extrauterine and 15 intrauterine). Only those patients with intrauterine misplacements in whom conventional blind removal was not possible were included in the study. All of the 15 misplaced intrauterine devices could be removed hysteroscopically; 22 of the 30 extrauterine misplaced devices (73%) could be removed laparoscopically. One patient required both laparoscopy and hysteroscopy. Only 7 (15.5%) of 45 patients required laparotomy for safe removal of misplaced devices. Considerable comfort and minimal hospital stay associated with endoscopic procedures should offer these as the first line attempt to remove a misplaced intrauterine or extrauterine translocated device.

The pathology of intra-uterine contraceptive devices

The IUCD is a simple and effective way of producing contraception without the need for patient compliance. It is not rendered ineffective by other drugs, as may be steroid contraceptives, and its side-effects, for carefully selected patients, are considered by most practitioners to be acceptably low (Van Kets et al. 1989).

Laparoscopic removal of translocated intrauterine contraceptive devices

Data is presented regarding 20 translocated intrauterine contraceptive devices (IUCD). Successful laparoscopic removal was made in 13 (65%) cases though all these devices were Copper 'T' 200 model which tend to produce dense adhesions. Only when the IUCD was suspected to be partially or fully in the gut lumen or thick adhesions were present, or the device was not visualised, was laparotomy performed. Hence it is advocated that laparoscopy should be performed as a routine in patients with suspected translocated IUCD, as it obviates the need for laparotomy and thus decreases the duration of the hospital stay as well as preventing morbidity associated with laparotomy.