1
|
Tabatabaei F, Hosseini STN, Hakimi P, Vejdani R, Khademi B. Risk factors of uterine perforation when using contraceptive intrauterine devices. BMC Womens Health 2024; 24:538. [PMID: 39334324 PMCID: PMC11428400 DOI: 10.1186/s12905-024-03298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 06/07/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Intrauterine devices (IUDs) are one of the most popular methods of contraception, and uterine perforation has been presented among the most significant potential complications of IUD use. The aim of this study is to evaluate the risk factors of uterine perforation when using an IUD. METHODS In this retrospective study, all 164 women who have referred to Al-Zahra hospital in Tabriz- Iran to remove the retained IUD from March 2018 to March 2021, were investigated in two groups. Patients in case group underwent surgery to remove the dislocated device and management of its complications. In control group, the devices were removed using a Novak or ring forceps with or without hysteroscopy with no uterine perforation. Data were analyzed using SPSS software, and P < 0.05 was considered statistically significant. P-Value was obtained for qualitative data via Fisher's exact test and Chi-Squared test and for quantitative data via Mann-Whitney U test and independent T-test. RESULTS The mean age of patients in the groups with or without uterine perforation was 30.57 and 36.78 years respectively (P = 0.01). The frequency of two or more parities among patients with uterine perforation was higher than other patients (P = 0.13). Ultrasound study before (p = 0.037) and after (p = 0.007) IUD insertion was higher among patients without uterine perforation. The less inexperience of healthcare providers (P = 0.013) and lack of scheduled follow-up visits after the IUD insertion (P < 0.001), are the other important factors affecting the uterine perforation. Abdominal pain was the most common compliant of uterine perforation (P < 0.001) and laparoscopy was the most used surgery to remove the misplaced device. CONCLUSION Uterine perforation can be effectively prevented by hiring experienced health care providers and appropriate patient selection.
Collapse
Affiliation(s)
- Fatemeh Tabatabaei
- Women's Reproductive Health Research Center, Al‑Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
- Endometriosis Research Center, Iranian Society of Minimally Invasive Gynecology, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Parvin Hakimi
- Women's Reproductive Health Research Center, Al‑Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Razieh Vejdani
- Department of Obstetrics and Gynecology, Shahid Beheshti Hospital, Maragheh University of Medical Sciences, Maragheh, Iran.
| | - Bahareh Khademi
- Women's Reproductive Health Research Center, Al‑Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
2
|
Houmaid H, Harou K, Fakhir B, Bassir A, Boukhanni L, Aboulfalah A, Asmouki H, Soummani A. Migration of an intrauterine contraceptive device into the bladder complicated by stone formation an exceptional complication: case report and literature review. Contracept Reprod Med 2024; 9:42. [PMID: 39192372 DOI: 10.1186/s40834-024-00302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND We report a rare and unusual case of intravesical migration of an intrauterine device with stone formation. The intrauterine device (IUD) is the most common method of reversible contraception in women. However, its insertion is not without risk, it can cause early or late complications. IUD can perforate the uterus wall and migrate into adjacent structures. CASE PRESENTATION A 35 year-old female 5 gravid, 4 para has been benefited from intrauterine contraceptive device (IUCD) 5 years ago, she was presented to gynecological consultation for chronic pelvic pain with urinary symptoms. There was history of a good IUD insertion 5 years ago, considered expelled after one month of its pose. Physical examination was normal, but a pelvic ultrasound and a plain abdominal radiography allowed the detection of an IUD outside the uterine cavity, but inside bladder. A diagnostic and therapeutic cystoscopy was performed, and the IUD with calculus was successfully removed. There were no postoperative complications. CONCLUSION This case is reported to highlight and to reiterate the need to think about one of the rare complication of IUD insertion, which every practitioner must know, it's the transuterovesical migration, before concluding wrongly to its expulsion. It's a consequence of, non-compliance with the rules for inserting an IUD and poor monitoring. The evolution towards calcification is a certain consequence; its screening involves rigorous clinical monitoring.
Collapse
Affiliation(s)
- Hanane Houmaid
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco.
| | - Karam Harou
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Bouchra Fakhir
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Ahlam Bassir
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Lahcen Boukhanni
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Abderrahim Aboulfalah
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Hamid Asmouki
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| | - Abderraouf Soummani
- Gynecology Obstetrics Departement, Mohammed the VI University Medical Center, Cadi Ayyad University, Marrakesh, Morocco
| |
Collapse
|
3
|
Seto E, Liu EN, Pereira N. Perforated intrauterine device in the abdomen: leave or retrieve? J Minim Invasive Gynecol 2024:S1553-4650(24)00353-4. [PMID: 39182570 DOI: 10.1016/j.jmig.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/27/2024]
Affiliation(s)
- Erin Seto
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Nigel Pereira
- Mount Sinai Fertility, Toronto, ON, Canada; Division of Gynecologic Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
4
|
Liu C, Xia Y, Pang Q, Zhao Z, Zhao J. Migration of an intrauterine device to the posterior urethra with stone formation: a case report. Front Med (Lausanne) 2024; 11:1449443. [PMID: 39238594 PMCID: PMC11375611 DOI: 10.3389/fmed.2024.1449443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 08/12/2024] [Indexed: 09/07/2024] Open
Abstract
Migration of an intrauterine device (IUD) to the posterior urethra with stone formation has not been previously reported in the literature. A 42-year-old female patient presented to the gynecology clinic with a complaint of "discovered vaginal mass for 2 years, with growth for 5 days." She was referred to urology on suspicion of IUD migration to the bladder. Physical examination revealed a hard mass palpable on the anterior vaginal wall. Laboratory tests showed normal blood counts, and urinalysis indicated a mild urinary tract infection. Ultrasound and pelvic X-ray indicated IUD migration to the bladder and bladder stones. Cystoscopy revealed that the IUD had migrated to the posterior urethra with stone formation. Holmium laser was used to fragment the stones encasing the IUD's one arm, and the IUD was successfully removed with grasping forceps. The patient had a urinary catheter placed for 10 days and was followed up for 20 days. During the follow-up, there were no lower urinary tract symptoms (LUTS) or vaginal leakage. To our knowledge, we report the first case of an IUD migrating through the vesicovaginal space to the posterior urethra. Endoscopic removal of the IUD is feasible and safe. Urologists and gynecologists should not limit their diagnosis to IUD migration to the bladder but should also consider the possibility of urethral migration.
Collapse
Affiliation(s)
- Chuanfeng Liu
- Department of Urology, Linyi Maternity and Child Health Care Hospital, Linyi, Shandong, China
| | - Yongqiang Xia
- Department of Urology, Linyi Maternity and Child Health Care Hospital, Linyi, Shandong, China
| | - Qingtan Pang
- Department of Urology, Linyi Maternity and Child Health Care Hospital, Linyi, Shandong, China
| | - Zichao Zhao
- Department of Urology, Linyi Maternity and Child Health Care Hospital, Linyi, Shandong, China
| | - Jianfang Zhao
- Department of Gynecology, Linyi Maternity and Child Health Care Hospital, Linyi, Shandong, China
| |
Collapse
|
5
|
Han JH, Yu EH, Joo JK, Kim MJ, Choi JB, Jung HJ, Jo HJ, Lee BC. Laparoscopic management of bowel perforation secondary to levonorgestrel-releasing intrauterine device migration: a case report and review of literature. J Surg Case Rep 2024; 2024:rjae522. [PMID: 39220169 PMCID: PMC11364457 DOI: 10.1093/jscr/rjae522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Bowel perforation secondary to a levonorgestrel-releasing intrauterine device is exceptionally rare. We present the case of a woman who exhibited abnormal findings during a colonoscopy examination. Despite undergoing an intrauterine device (IUD) insertion procedure for contraception in 2000, attempts for its removal in 2007 were unsuccessful due to the inability to locate the IUD. In 2022, she presented with intermittent hematochezia and lower left abdominal pain. Subsequent colonoscopy and abdominal computed tomography confirmed the presence of the IUD penetrating the uterine wall and entering the colon. Laparoscopic anterior resection was performed, and the patient's postoperative recovery was uneventful, indicating the viability of laparoscopic treatment as a valuable option.
Collapse
Affiliation(s)
- Jeong Hee Han
- Department of Surgery, Pusan National University School of Medicine, Pusan National University Hospital Biomedical Research Institute, Busan 46241, Republic of Korea
| | - Eun Hee Yu
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Biomedical Research Institute, Busan 46241, Republic of Korea
| | - Jong Kil Joo
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan National University Hospital Biomedical Research Institute, Busan 46241, Republic of Korea
| | - Min Ju Kim
- Department of Surgery, Pusan National University School of Medicine, Pusan National University Hospital Biomedical Research Institute, Busan 46241, Republic of Korea
| | - Jung Bum Choi
- Department of Surgery, Pusan National University School of Medicine, Pusan National University Hospital Biomedical Research Institute, Busan 46241, Republic of Korea
| | - Hyuk Jae Jung
- Department of Surgery, Pusan National University School of Medicine, Pusan National University Hospital Biomedical Research Institute, Busan 46241, Republic of Korea
| | - Hong Jae Jo
- Department of Surgery, Pusan National University School of Medicine, Pusan National University Hospital Biomedical Research Institute, Busan 46241, Republic of Korea
| | - Byoung Chul Lee
- Department of Surgery, Pusan National University School of Medicine, Pusan National University Hospital Biomedical Research Institute, Busan 46241, Republic of Korea
| |
Collapse
|
6
|
Oliver JJ, Kelly EP, Aller FC, Bridwell RE, Stremick JK. Carrying a Pregnancy to Term With an Intrauterine Device in Place: A Case of an Intraabdominal Intrauterine Device Migration. Cureus 2024; 16:e63097. [PMID: 39055418 PMCID: PMC11270807 DOI: 10.7759/cureus.63097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Long-acting intrauterine contraceptives such as intrauterine devices (IUD) are popular due to their high rates of long-term efficacy, ease of use, and reversibility. Though rare, these devices can incur complications such as uterine perforation. Signs and symptoms are often vague abdominal and pelvic pain, and patients rarely present with a surgical emergency. This uterine perforation can happen immediately upon IUD placement or in a delayed manner. This case details an example of an IUD uterine perforation with abdominal migration two years after placement. The patient's history is complicated by the unique fact that she became pregnant and carried her pregnancy to a term vaginal delivery after the IUD had been placed. Her pregnancy led healthcare providers from previous encounters to believe that the IUD had been spontaneously expelled. The IUD was identified in the patient's left lower abdominal cavity via computed tomography (CT) and was surgically removed uneventfully.
Collapse
Affiliation(s)
- Joshua J Oliver
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, USA
| | - Ethan P Kelly
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, USA
| | - Forest C Aller
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, USA
| | - Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, USA
| | - Justine K Stremick
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, USA
| |
Collapse
|
7
|
Verstraeten V, Vossaert K, Van den Bosch T. Migration of Intra-Uterine Devices. Open Access J Contracept 2024; 15:41-47. [PMID: 38495451 PMCID: PMC10944303 DOI: 10.2147/oajc.s458156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Intrauterine devices (IUDs) are a widely used contraceptive. Possible complications from IUDs include failed insertion, pain, vasovagal reaction, infection, abnormal bleeding, and expulsion. Uterine perforation and migration of the IUD are rare complications occurring in approximately 1-2 per 1000 insertions. We executed a systematic review by reviewing all case reports and case series on IUD migration, published between December 2002 and December 2022. Our review indicates that about half of these patients present with pain and that a third are completely asymptomatic. The most common sites of migration are the intestine, bladder, and omentum. We found that the preferred method for removing the migrated IUD is laparoscopy. Generally, there are no lasting injuries after the removal of the migrated IUD, but occasionally, severe complications have been reported. Healthcare providers should be vigilant about this rare complication, especially in cases of painful insertion or the presence of other risk factors for perforation. When uterine perforation is diagnosed, it is advisable to remove the IUD to prevent severe complications.
Collapse
Affiliation(s)
- Victoria Verstraeten
- Obstetrics & Gynaecology - UZ Leuven Gasthuisberg, Leuven, Belgium
- Obstetrics & Gynaecology – AZ Sint- Blasius Dendermonde, Dendermonde, Belgium
| | - Karlien Vossaert
- Obstetrics & Gynaecology – AZ Sint- Blasius Dendermonde, Dendermonde, Belgium
| | | |
Collapse
|
8
|
Karkin K, Vuruşkan E, Aydamirov M, Kaplan E, Aksay B, Gürlen G. Hydronephrosis Due to Intraureteral Migration of Missed Intrauterine Device. Cureus 2024; 16:e53820. [PMID: 38465132 PMCID: PMC10924242 DOI: 10.7759/cureus.53820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Migration of intrauterine devices (IUDs) to the ureter causing ureteral obstruction is an extremely rare event. A 45-year-old female patient was admitted to our hospital with a complaint of pain in the right flank and inferior right quadrant of the abdomen. On genitourinary system ultrasonography, grade 3 hydronephrosis was found in the right kidney. On the abdominopelvic radiography, there was an appearance consistent with two IUDs, one in the region consistent with the course of the right distal ureter and the other in the usual localisation. The first IUD was thought to have spontaneously detached from the uterus, so a second IUD was implanted. A right-sided extravesical ureteroneocystostomy (Lich-Gregoir) operation was performed. The operation was terminated with the placement of a 4.8 French, 26 cm double-J stent in the ureter. The patient was followed up in our hospital for 26 months and she was asymptomatic during follow-up, hydronephrosis was resolved completely, and no complications were encountered during follow-up clinical and ultrasonography examinations.
Collapse
Affiliation(s)
- Kadir Karkin
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, TUR
| | - Ediz Vuruşkan
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, TUR
| | - Mubariz Aydamirov
- Department of Urology, Başkent University, Alanya Application and Research Center, Antalya, TUR
| | - Eyüp Kaplan
- Department of Urology, Abdulkadir Yüksel State Hospital, Gaziantep, TUR
| | - Bugra Aksay
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, TUR
| | - Güçlü Gürlen
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, TUR
| |
Collapse
|
9
|
Gebremichael A, Teka H, Abadi KK, Siferih M, Moges M, Arusi M, Shiferaw A. Missed Diagnosis of Perforation and Intraperitoneal Migration of an Intrauterine Device and Its Management in a Resource-Limited Setting: A Case Report. Int Med Case Rep J 2024; 17:71-76. [PMID: 38293615 PMCID: PMC10826545 DOI: 10.2147/imcrj.s441386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
Background The intrauterine device is a popular and highly effective form of long-acting reversible contraception. Although generally safe, complications could happen. One of the most serious complications of intrauterine device use is uterine perforation. Risk factors for perforation include, but are not limited to, postpartum period, breastfeeding, levels of experience, and excessive force exerted during insertion. This case is significant because it demonstrates risk factors for uterine perforation, how to handle missing strings, and care in places with little resources. Case Presentation We discuss the case of a 27-year-old black Ethiopian woman who presented with chronic pelvic pain and had a perforated intrauterine device discovered in the cul-de-sac. The device had been inserted at six weeks postpartum. The client was unable to feel the strings three months after insertion, and a wrong diagnosis of expulsion was made. After one year of insertion, the intrauterine device was located on a plain abdominal radiograph and removed via laparotomy without complications. Conclusion Although uterine perforation is a rare complication of intrauterine device insertion, special attention should be paid to women with risk factors. In the absence of a witnessed expulsion, assessments and investigations should be carried out before declaring a device expelled. In patients with chronic pelvic pain complaints in the presence of an intrauterine device, perforation and migration outside the uterine cavity should be considered. Abdominal X-rays and laparotomies can be used to find and manage extrauterine migrating devices in environments with limited resources.
Collapse
Affiliation(s)
- Akebom Gebremichael
- Department of Obstetrics and Gynecology, St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia
| | - Hale Teka
- Department of Obstetrics and Gynecology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidus Kebede Abadi
- Department of Obstetrics and Gynecology, Riwyet Maternal and Child Health Center, Tigray, Ethiopia
| | - Melkamu Siferih
- Department of Obstetrics and Gynecology, Debre Markos University, Debre Markos, Ethiopia
| | - Menberu Moges
- Department of Obstetrics and Gynecology, Tayo Hospital, Baidoa, Somalia
| | - Muhudin Arusi
- Department of Obstetrics and Gynecology, St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia
| | - Abel Shiferaw
- Department of Obstetrics and Gynecology, Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
| |
Collapse
|
10
|
Barton BE, Erickson JA, Allred SI, Jeffries JM, Stephens KK, Hunter MI, Woodall KA, Winuthayanon W. Reversible female contraceptives: historical, current, and future perspectives†. Biol Reprod 2024; 110:14-32. [PMID: 37941453 PMCID: PMC10790348 DOI: 10.1093/biolre/ioad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
Contraception is a practice with extensive and complicated social and scientific histories. From cycle tracking, to the very first prescription contraceptive pill, to now having over-the-counter contraceptives on demand, family planning is an aspect of healthcare that has undergone and will continue to undergo several transformations through time. This review provides a comprehensive overview of current reversible hormonal and non-hormonal birth control methods as well as their mechanism of action, safety, and effectiveness specifically for individuals who can become pregnant. Additionally, we discuss the latest Food and Drug Administration (FDA)-approved hormonal method containing estetrol and drospirenone that has not yet been used worldwide as well as the first FDA-approved hormonal over-the-counter progestin-only pills. We also review available data on novel hormonal delivery through microchip, microneedle, and the latest FDA-approved non-hormonal methods such as vaginal pH regulators. Finally, this review will assist in advancing female contraceptive method development by underlining constructive directions for future pursuits. Information was gathered from the NCBI and Google Scholars databases using English and included publications from 1900 to present. Search terms included contraceptive names as well as efficacy, safety, and mechanism of action. In summary, we suggest that investigators consider the side effects and acceptability together with the efficacy of contraceptive candidate towards their development.
Collapse
Affiliation(s)
- Brooke E Barton
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Jeffery A Erickson
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
- Translational Bioscience Program, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Stephanie I Allred
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Jenna M Jeffries
- College of Art & Science, Washington State University, Pullman, WA, USA
| | - Kalli K Stephens
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
- Translational Bioscience Program, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Mark I Hunter
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Kirby A Woodall
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Wipawee Winuthayanon
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| |
Collapse
|
11
|
Zhu GG, Ludwig DR, Rogers DM, Olpin JD, Barker E, Freeman EA, Eisenberg DL, Siegel CL. CT imaging of intrauterine devices (IUD): expected findings, unexpected findings, and complications. Abdom Radiol (NY) 2024; 49:237-248. [PMID: 37907685 DOI: 10.1007/s00261-023-04052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 11/02/2023]
Abstract
Intrauterine devices (IUDs) are a commonly used form of long-acting reversible contraception, which either contain copper or levonorgestrel to prevent pregnancy. Although symptomatic patients with indwelling IUDs may first undergo ultrasound to assess for device malposition and complications, IUDs are commonly encountered on CT in patients undergoing evaluation for unrelated indications. Frequently, IUD malposition and complications may be asymptomatic or clinically unsuspected. For these reasons, it is important for the radiologist to carefully scrutinize the IUD on any study in which it is encountered. To do so, the radiologist must recognize that normally positioned IUDs are located centrally within the uterine cavity. IUDs are extremely effective in preventing pregnancy, though inadvertent pregnancy risk is higher with malpositioned IUDs. Presence of fibroids or Mullerian abnormalities may preclude proper IUD placement. Radiologists play an important role in identifying complications when they arise and special considerations when planning for an IUD placement. There is a wide range of IUD malposition, affecting IUDs differently depending on the type of IUD and its mechanism of action. IUD malposition is the most common complication, but embedment and/or partial perforation can and can lead to difficulty when removed. Retained IUD fragments can result in continued contraceptive effect. Perforated IUDs do not typically cause intraperitoneal imaging findings.
Collapse
Affiliation(s)
- Grace G Zhu
- Department of Radiology, University of Utah Health, 30 North Mario Capecchi Dr, 2 South, Salt Lake City, UT, 84112, USA.
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
| | - Daniel R Ludwig
- Mallickrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
| | - Douglas M Rogers
- Department of Radiology, University of Utah Health, 30 North Mario Capecchi Dr, 2 South, Salt Lake City, UT, 84112, USA
| | - Jeffrey D Olpin
- Department of Radiology, University of Utah Health, 30 North Mario Capecchi Dr, 2 South, Salt Lake City, UT, 84112, USA
| | - Emily Barker
- Planned Parenthood of St. Louis Region, 4251 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Emily A Freeman
- OB/GYN and Women's Health Clinic, Cleveland Clinic, 850 Columbia Road Suite 330, Cleveland, OH, 44145, USA
| | - David L Eisenberg
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave, Mailstop 8064-37-1005, St. Louis, MO, 63110, USA
| | - Cary L Siegel
- Mallickrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
| |
Collapse
|
12
|
Nguyen BT, Heyrana K, Ohsfeldt R, Johnston A, Summers K. Descriptive study of the real-world, long-term cost estimates and duration of use for hormonal and nonhormonal intrauterine devices using US commercial insurance claims. J Manag Care Spec Pharm 2023; 29:1303-1311. [PMID: 38058139 PMCID: PMC10776262 DOI: 10.18553/jmcp.2023.29.12.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND Intrauterine devices (IUDs) have comparable efficacy to permanent surgical contraceptive methods; however, long-term costs are infrequently considered. Existing estimates inconsistently account for costs outside of IUD insertion or removal, actual duration of use, or differences between hormonal and nonhormonal IUDs. OBJECTIVE To describe health care resource utilization and commercial payer costs that arise throughout hormonal and nonhormonal IUD use. METHODS In this retrospective cohort study, paid claims data (Merative, MarketScan) from a large US commercial claims database were evaluated between 2013 and 2019. Claims were included from individuals aged 12 to 45 years who had an IUD inserted in 2014, continuous insurance coverage for 1 year prior to insertion and throughout follow-up, and no insertion, removal, or reinsertion in the previous year. Procedures and services that could be IUD-related were identified using Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Edition codes. Duration of IUD use was evaluated by Kaplan-Meier analysis of time to IUD removal. Event rates were determined for identified procedures and services; costs were calculated as the sum of payer reimbursements per enrolled individual. All IUD types available during the study period were described: 2 hormonal IUDs (52-mg and 13.5-mg levonorgestrel-releasing [LNG]) and the nonhormonal (380-mm2 copper) IUD. RESULTS Of 195,009 individuals meeting the age requirement and receiving an IUD in 2014, 63,386 met the inclusion criteria and 53,744 had their IUD type on record-42,777 (67.5%) 52-mg LNG, 2,932 (4.6%) 13.5-mg LNG, and 8,035 (12.7%) nonhormonal IUD users. Despite differences in their indicated duration (13.5-mg LNG, 3 years; 52-mg LNG, 5 years; and nonhormonal, 10 years), most individuals had their IUD removed before its indicated full duration of use (13.5-mg LNG, 56.1%; 52-mg LNG, 61.3%; nonhormonal [at 5 years], 54.6%). The event rate per 100 individuals during the follow-up period was highest for abnormal uterine bleeding (16.2), ovarian cysts (9.3), and surgical management of uterine perforations (4.5). IUD insertion costs (mean ± SE) per enrolled individual for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $931 ± $9, $1,107 ± $4, and $897 ± $6, respectively. Cumulative mean ± SE 5-year postinsertion costs for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $2,892 ± $232, $1,514 ± $31, and $1,389 ± $97, respectively, among the remaining enrolled individuals. CONCLUSIONS In this descriptive study of commercially insured IUD users, at least half had their IUD removed before its indicated duration. IUD improvements that reduce the frequency of abnormal uterine bleeding, ovarian cysts, and uterine perforations may help reduce long-term IUD costs.
Collapse
Affiliation(s)
- Brian T. Nguyen
- Department of Clinical Obstetrics & Gynecology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Katrina Heyrana
- Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert Ohsfeldt
- Texas A&M School of Public Health, College Station
- Medical Decision Modeling, Inc., Indianapolis, IN
| | | | - Kent Summers
- AlphaScientia, a Red Nucleus company, King of Prussia, PA
| |
Collapse
|
13
|
Amaya SI, Blumenthal PD. Management of missing intrauterine device strings and migrated intrauterine devices. Curr Opin Obstet Gynecol 2023; 35:496-500. [PMID: 37610992 DOI: 10.1097/gco.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to review the recent literature with respect to the management of missing intrauterine device (IUD) strings. As IUD use has increased over time, it is important to review management options for this uncommon but possible complication. RECENT FINDINGS This article will cover stepwise approaches to management of missing IUD strings based on the most recent literature. Initial steps include obtaining history and using in office tools to reveal IUD strings. Subsequent steps focus on imaging guidelines including obtaining transvaginal ultrasound when available. Finally, IUD removal with tools for uterine instrumentation are discussed, focusing on using tools that do not require cervical dilation and allow for grasping of the device. SUMMARY This paper details a stepwise approach to the management of missing IUD strings which, as discussed in the article, may become more frequent given the rise of IUD use in general and postpartum placement in specific.
Collapse
Affiliation(s)
- Stephanie I Amaya
- Management of Missing IUD Strings and Migrated IUDs and Department of Obstetrics and Gynecology Stanford University School of Medicine, Stanford, USA
| | | |
Collapse
|
14
|
Su Z, Diao T, McGuire H, Yao C, Yang L, Bao G, Xu X, He B, Zheng Y. Nanomaterials Solutions for Contraception: Concerns, Advances, and Prospects. ACS NANO 2023; 17:20753-20775. [PMID: 37856253 DOI: 10.1021/acsnano.3c04366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Preventing unintentional pregnancy is one of the goals of a global public health policy to minimize effects on individuals, families, and society. Various contraceptive formulations with high effectiveness and acceptance, including intrauterine devices, hormonal patches for females, and condoms and vasectomy for males, have been developed and adopted over the last decades. However, distinct breakthroughs of contraceptive techniques have not yet been achieved, while the associated long-term adverse effects are insurmountable, such as endocrine system disorder along with hormone administration, invasive ligation, and slowly restored fertility after removal of intrauterine devices. Spurred by developments of nanomaterials and bionanotechnologies, advanced contraceptives could be fulfilled via nanomaterial solutions with much safer and more controllable and effective approaches to meet various and specific needs for women and men at different reproductive stages. Nanomedicine techniques have been extended to develop contraceptive methods, such as the targeted drug delivery and controlled release of hormone using nanocarriers for females and physical stimulation assisted vasectomy using functional nanomaterials via photothermal treatment or magnetic hyperthermia for males. Nanomaterial solutions for advanced contraceptives offer significantly improved biosafety, noninvasive administration, and controllable reversibility. This review summarizes the nanomaterial solutions to female and male contraceptives including the working mechanisms, clinical concerns, and their merits and demerits. This work also reviewed the nanomaterials that have been adopted in contraceptive applications. In addition, we further discuss safety considerations and future perspectives of nanomaterials in nanostrategy development for next-generation contraceptives. We expect that nanomaterials would potentially replace conventional materials for contraception in the near future.
Collapse
Affiliation(s)
- Zhenning Su
- NHC Key Laboratory of Reproductive Health Engineering Technology Research, Department of Reproduction Physiology, National Research Institute for Family Planning, Beijing 100081, China
- Graduate School of Peking Union Medical College, Beijing 100730, China
| | - Tian Diao
- NHC Key Laboratory of Reproductive Health Engineering Technology Research, Department of Reproduction Physiology, National Research Institute for Family Planning, Beijing 100081, China
- Graduate School of Peking Union Medical College, Beijing 100730, China
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Helen McGuire
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Cancan Yao
- NHC Key Laboratory of Reproductive Health Engineering Technology Research, Department of Reproduction Physiology, National Research Institute for Family Planning, Beijing 100081, China
- Graduate School of Peking Union Medical College, Beijing 100730, China
| | - Lijun Yang
- NHC Key Laboratory of Reproductive Health Engineering Technology Research, Department of Reproduction Physiology, National Research Institute for Family Planning, Beijing 100081, China
- Graduate School of Peking Union Medical College, Beijing 100730, China
| | - Guo Bao
- NHC Key Laboratory of Reproductive Health Engineering Technology Research, Department of Reproduction Physiology, National Research Institute for Family Planning, Beijing 100081, China
| | - Xiaoxue Xu
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia
- School of Science, Western Sydney University, Kumamoto NSW 2751, Australia
| | - Bin He
- NHC Key Laboratory of Reproductive Health Engineering Technology Research, Department of Reproduction Physiology, National Research Institute for Family Planning, Beijing 100081, China
| | - Yufeng Zheng
- School of Materials Science and Engineering, Peking University, Beijing 100871, China
- International Research Organization for Advanced Science and Technology, Kumamoto University, 2-39-1 Kurokami, Chuo-Ku, Kumamoto 860-8555, Japan
| |
Collapse
|
15
|
Zare SH, Sohrabi R, Sohrabi H. Pregnancy with Intrauterine Device Perforation: A Case Report. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2023; 18:91-93. [PMID: 38041466 PMCID: PMC10692752 DOI: 10.22074/ijfs.2023.1974526.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/30/2023] [Accepted: 06/25/2023] [Indexed: 12/03/2023]
Abstract
Although intrauterine devices (IUDs) are known for their low failure rate in pregnancy prevention, potential risks associated with their use include uterine perforation and migration through the abdomen. In this particular case, the patient experienced simultaneous IUD failure and perforation, with the device becoming embedded in an omentum. A 28-year-old woman who was 39 weeks plus one day gestation presented for caesarean section. During the caesarean section, it was discovered that the IUD had entered the omentum through a hole in the posterior part of the uterus. The result of the birth was a live boy. IUD perforation is most commonly observed during the insertion procedure; however, it may rarely occur at a later stage. IUD perforations are frequently asymptomatic and remain undetected until follow-up assessments are conducted or clinical manifestations become apparent. The presence of gastrointestinal symptoms is commonly observed in cases with intraperitoneal migration of the IUD. Although the occurrence of abdominal pain, diarrhoea, and fever with a missing IUD are indicative, they may not always be present. Nonspecific signs and symptoms lead to misdiagnosis and the consequent delay in initiating appropriate treatment. In the present case, the co-occurrence of IUD embedded in the omentum and pregnancy posed a challenge due to the device's rapid and imprecise shift, which complicated its accurate localisation. In such scenarios, ultrasonographic guidance can serve as a valuable tool to enhance accuracy and decrease adverse outcomes.
Collapse
Affiliation(s)
- S Hamsi Zare
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Rozbeh Sohrabi
- Students' Research Committee, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hana Sohrabi
- Students' Research Committee, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| |
Collapse
|
16
|
Saputra AND, Permatasari NUI. Intrauterine device migration into the bladder leading to stones formation. BMJ Case Rep 2023; 16:e256547. [PMID: 37879705 PMCID: PMC10603394 DOI: 10.1136/bcr-2023-256547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
An intrauterine device (IUD) is a popular method of contraception mainly used in developing countries. Perforation is one of the most serious but a rare complication secondary to the insertion of an IUD, while perforation into the intravesical organs such as the bladder is even more rare. A 30-year-old multipara in early 30s, with two previous caesarean sections (CS) and one curettage, was found to have her IUD puncturing the bladder during a cystoscopy procedure to remove her bladder stones. Transvesical migration of an IUD is an uncommon complication with a high rate of calculi formation, which is thought to be caused by the IUD's lithogenic potential. Imaging approaches such as ultrasound and pelvic X-rays are considered imperative in the accurate diagnosis. Any migrated IUD should be removed regardless of location. Prompt and continual monitoring of women using an IUD is essential and in a case where the IUD has migrated, the removal using the endoscopic approach is a safe and effective method.
Collapse
|
17
|
Aljohani A, Alzarea AA, Alnafee R, Aljadaani KS, Sairafi R, Alzahrani A. Migrated intrauterine device: Case series report. Int J Surg Case Rep 2023; 111:108631. [PMID: 37757734 PMCID: PMC10978329 DOI: 10.1016/j.ijscr.2023.108631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Implantation of an intrauterine device (IUD) is a common method of contraception in Saudi Arabia. Although rare, IUD migration and colon perforation have been reported. The current report presented three cases of IUD migration into the colon and recto-uterine pouch. METHODS AND OUTCOMES The study included a series of three cases of migrated IUDs. The first case was a 25-year-old female, Gravida 2, Para 2 + 0, at 28 week-gestation, who presented with abdominal pain with a history of IUD placement that had not been removed or imaged before. The patient submitted to the caesarian section (CS), where IUD was found in the sigmoid colon. Elective laparoscopic removal of IUD with resection and primary repair of sigmoid colon was done later. The second case was a 37-year-old female, Gravida 1, Para 1 + 0, non-pregnant hypothyroidism, and a history of IUD placement. The patient got pregnant and gave birth through CS. She was then presented with abdominal pain and requested the removal of the IUD. On colonoscopy, IUD was seen in the pouch of Douglas with no evidence of a fistulous tract. IUD was removed through laparoscopy. The third case was a 47-year-old female, Gravida 14, Para 14 + 0, with a history of previous CS presented with a missing IUD that had been inserted 20 years ago after she had five pregnancies and subsequent deliveries. On colonoscopy, IUD was embedded on the wall of the transverse colon, and through abdominal surgery, IUD was removed by cutting through the colon and primary repair was done. CLINICAL DISCUSSION: the presentation of IUD migration cases was foundto vary according to the site of migration and type of IUD.however the cases are usually present with abdominal pain. An abdominal pelvic imaging with CT in these patients are essential in diagnosis. Retrival of migrating IUDs may be done through colonoscopy, laparoscopy, and in some cases with adhesion laparotomy is the solution. CONCLUSION Abdominal and pelvic CT scan are very important in the diagnosis and the localization of IUD. Elective colonoscopy and laparoscopy are successful management approaches for these cases.
Collapse
Affiliation(s)
- Alaa Aljohani
- General Surgery Department, Security Force Hospital, Riyadh, Saudi Arabia
| | | | - Reem Alnafee
- General Surgery Department, Security Force Hospital, Riyadh, Saudi Arabia
| | | | - Rami Sairafi
- General Surgery Department, Security Force Hospital, Riyadh, Saudi Arabia
| | - Ali Alzahrani
- General Surgery Department, Security Force Hospital, Riyadh, Saudi Arabia.
| |
Collapse
|
18
|
Rauf SA, Ahmed R, Ahmed S, Hussain T, Zehrah SA. Enhancing the quality of long-acting reversible contraception (LARC) uptake: acknowledging and addressing potential drawbacks and limitations. BJOG 2023. [PMID: 37661297 DOI: 10.1111/1471-0528.17659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Affiliation(s)
| | | | - Shaheer Ahmed
- Dow University of Health Sciences, Karachi, Pakistan
| | - Tooba Hussain
- Dow University of Health Sciences, Karachi, Pakistan
| | | |
Collapse
|
19
|
Michener JL, Hirsh DA, Batur P, Casas RS, Gopinath V, Pace LE, Prifti C, Rusiecki J, Schwarz EB, Shankar M, Sobota M, Gomez Kwolek D. Credentialing Internal Medicine Physicians to Expand Long-Acting Reversible Contraceptive Access. Ann Intern Med 2023; 176:1121-1123. [PMID: 37523694 DOI: 10.7326/m23-1034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Affiliation(s)
| | - David A Hirsh
- Harvard Medical School, Boston, Massachusetts, and Cambridge Health Alliance, Cambridge, Massachusetts (D.A.H.)
| | - Pelin Batur
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio (P.B.)
| | - Rachel S Casas
- Penn State College of Medicine, Hershey, Pennsylvania (R.S.C., M.S.)
| | - Vidya Gopinath
- Warren Alpert Medical School of Brown University, Providence, Rhode Island (V.G., M.S.)
| | - Lydia E Pace
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (L.E.P.)
| | - Christine Prifti
- Boston University School of Medicine, Boston, Massachusetts (C.P.)
| | - Jennifer Rusiecki
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois (J.R.)
| | - Eleanor Bimla Schwarz
- San Francisco General Hospital, University of California, San Francisco, California (E.B.S.)
| | - Megha Shankar
- Penn State College of Medicine, Hershey, Pennsylvania (R.S.C., M.S.)
| | - Mindy Sobota
- Warren Alpert Medical School of Brown University, Providence, Rhode Island (V.G., M.S.)
| | - Deborah Gomez Kwolek
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (D.G.K.)
| |
Collapse
|
20
|
Hodes R. 'Foreign body': a social history of Implanon in South Africa's Eastern Cape. CULTURE, HEALTH & SEXUALITY 2023; 25:1039-1054. [PMID: 36149788 DOI: 10.1080/13691058.2022.2121005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
This article explores the reception of the contraceptive implant, Implanon, by healthcare workers and patients in family planning units in South Africa's public health sector. Based on observations conducted at public health facilities in the Eastern Cape Province, and on interviews with nurses and patients in the same province, the study explored real-world experiences of the implant. This article examines the strategies used by nurses to promote use of the device, and explores how patients themselves responded to a widescale, national rollout of the implant within government family planning services. The study examines the reception of Implanon in the context of the post-Apartheid era in South Africa, in which the vestiges of Apartheid-era healthcare provision, and lack thereof, continue to animate personal experiences of contraception.
Collapse
Affiliation(s)
- Rebecca Hodes
- Centre for Sexualities, AIDS & Gender; and the Department of Historical and Heritage Studies, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
21
|
Almatary A, Alsharif A, Ghabisha S, Ahmed F, Badheeb M. Open surgical retrieval of intra-uterine contraceptive device perforating the ileum: A case report. Int J Surg Case Rep 2023; 109:108635. [PMID: 37552923 PMCID: PMC10425888 DOI: 10.1016/j.ijscr.2023.108635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Intra-uterine contraceptive devices (IUCDs) are globally acknowledged for their high utilization and tolerability as contraceptive techniques. However, the uncommon but critical complication of IUCD perforation and migration into the gastrointestinal (GI) system necessitates careful consideration. CASE PRESENTATION We present a case of IUCD migration culminating in ileal perforation in a 30-year-old female. The patient, with a history of IUCD insertion four years prior, manifested persistent abdominal discomfort lasting for a period of six months. Computed tomography (CT) scans of the abdomen disclosed the presence of an extraneous object perforating the uterine wall and penetrating the ileum. Surgical intervention substantiated the diagnosis, encompassing the removal of the IUCD and subsequent suturing to amend the bowel wall defect. The patient's post-operative recovery proceeded without additional complications. CLINICAL DISCUSSION Migration and GI perforation of the IUCD are uncommon complications, and require immediate attention and proper management. When there is a suspicion of a missing IUCD, obtaining radiologic confirmation and timely removal is crucial. CONCLUSION In females of reproductive age, persistent abdominopelvic pain warrants an evaluation of their IUCD placement history and a thorough examination. If the IUCD string is not visible, further radiological investigation is mandated. Any delay in diagnosis and the ensuing treatment may lead to significant, potentially catastrophic, organ damage.
Collapse
Affiliation(s)
- Abdullah Almatary
- Department of General Surgery, School of Medicine, Jeblah University for Medical and Health Sciences, Ibb, Yemen
| | - Afaf Alsharif
- Department of Gynaecology, School of Medicine, Jeblah University for Medical and Health Sciences, Ibb, Yemen.
| | - Saif Ghabisha
- Department of General Surgery, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen.
| | - Mohamed Badheeb
- Department of Internal Medicine, Faculty of Medicine, Hadhramaut University, Hadhramaut, Yemen
| |
Collapse
|
22
|
Al-Khatlan HS, Al-Tuhoo AM, Abu-Faza M, Obaid M, Abdelazim IA, Al-Kandari IM. Intraperitoneally Retained Contraceptive Device After Uterine Perforation: A Case Report. JOURNAL OF MOTHER AND CHILD 2023; 27:79-82. [PMID: 37409657 PMCID: PMC10323966 DOI: 10.34763/jmotherandchild.20232701.d-22-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/02/2023] [Indexed: 07/07/2023]
Abstract
A 29-year-old parous woman with a history of a T-shaped copper intrauterine device (IUD) insertion presented 8 months later with a complaint of the contraceptive device being missing. Computed tomography with contrast turned out to be superior to the combined abdominal and pelvic X-ray and transvaginal ultrasound in providing the detailed extrauterine location of the device between the urinary bladder and uterus. A laparoscopy was successful in the atraumatic freeing of the IUD from omental and bladder adhesions, and in its final removal.
Collapse
Affiliation(s)
- Hanan S Al-Khatlan
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Aliaa M Al-Tuhoo
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Mohannad Abu-Faza
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Mariam Obaid
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Ibrahim A Abdelazim
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Ibrahim M Al-Kandari
- Department of General and Laparoscopic Surgery, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| |
Collapse
|
23
|
Zhang M, Sun Z, Yang Y, Zhou J, Ba L. Complete perforated bladder from intrauterine devices: A case series report from a nationwide monitoring system. J Obstet Gynaecol Res 2023. [PMID: 37186345 DOI: 10.1111/jog.15661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
AIM Complete perforation of the bladder caused by an intrauterine device (IUD) is rare. This study examined the characteristics of patients associated with IUD-related bladder perforation and evaluated the relationship between mislocated IUDs and their potential complications. METHODS From October 2005 to December 2021, 13 reports regarding complete perforations to the bladder by IUDs were retrieved from the National Contraceptives Adverse Reaction Monitoring System of China. The clinical features of these cases were analyzed. RESULTS The median patient age was 30 (range, 27-46) years. There were four cases (4/13, 30.8%) with IUDs placed during lactation, one case (1/13, 7.7%) with an IUD placed after medical abortion, and eight cases (8/13, 61.5%) placed after menstruation. Seven cases (7/13, 53.9%) were first-time IUD users. The median duration of IUD placement was 47 (range, 1-145) months. Unexpected pregnancy was reported in five cases (5/13, 38.5%). Six cases (6/13, 46.2%) reported bladder stones with varying degrees of abdominal pain or urinary tract infection. Removal methods included laparotomy (four cases), cystoscopy (four cases), laparoscopy (two cases), laparoscopy combined with cystoscopy (two cases), and laparotomy after cystoscopy (one case). All IUDs were successfully removed. CONCLUSIONS Complete perforation to the bladder by IUDs is a rare adverse event. Regular follow-up is required after the placement of IUDs. The possibility of uterine perforation should be investigated if IUD users encounter persistent lower abdominal pain or urinary tract infection.
Collapse
Affiliation(s)
- Min Zhang
- Contraceptives Adverse Reaction Surveillance Center of National Health Commission, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
| | - Zhiming Sun
- Contraceptives Adverse Reaction Surveillance Center of National Health Commission, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
| | - Yuehua Yang
- Contraceptives Adverse Reaction Surveillance Center of National Health Commission, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
| | - Jian Zhou
- Contraceptives Adverse Reaction Surveillance Center of National Health Commission, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
| | - Lei Ba
- Contraceptives Adverse Reaction Surveillance Center of National Health Commission, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
| |
Collapse
|
24
|
Amaya SI, Henkel A, Blumenthal PD. Words matter: perforation… or transmural migration? BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:74-75. [PMID: 36564157 DOI: 10.1136/bmjsrh-2022-201738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Stephanie Irene Amaya
- Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Andrea Henkel
- Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Paul D Blumenthal
- Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
25
|
Yacobson I, Wanga V, Ahmed K, Chipato T, Gichangi P, Kiarie J, Louw C, Morrison S, Moss M, Mugo NR, Palanee-Phillips T, Pleaner M, Scoville CW, Thomas KK, Nanda K. Clinical outcomes of intrauterine device insertions by newly trained providers: The ECHO trial experience. Contracept X 2023; 5:100092. [PMID: 37188149 PMCID: PMC10176026 DOI: 10.1016/j.conx.2023.100092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 05/17/2023] Open
Abstract
Objectives To assess the rates of failed insertion, expulsion, and perforation when intrauterine device (IUD) insertions were done by newly trained clinicians, and to examine factors that may affect these outcomes. Study design We evaluated skill-based outcomes following IUD insertion at 12 African sites in a secondary analysis of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial. Before trial initiation, we provided competency-based IUD training to clinicians and offered ongoing clinical support. We used Cox proportional hazards regression to examine factors associated with expulsion. Results Among 2582 IUD acceptors who underwent first attempted IUD insertion, 141 experienced insertion failure (5.46%) and seven had uterine perforation (0.27%). Perforation was more common among breastfeeding women within three months postpartum (0.65%) compared with non-breastfeeding women (0.22%). We recorded 493 expulsions (15.5 per 100 person-years, 95% confidence interval [CI] 14.1─16.9): 383 partial and 110 complete. The risk of IUD expulsion was lower among women older than 24 years (aHR 0.63, 95% CI 0.50─0.78) and may be higher among nulliparous women. (aHR 1.65, 95% CI 0.97─2.82). Breastfeeding (aHR 0.94, 95% CI 0.72─1.22) had no significant effect on expulsion. IUD expulsion rate was highest during the first three months of the trial. Conclusions IUD insertion failure and uterine perforation rates in our study were comparable to those reported in the literature. These results suggest that training, ongoing support, and opportunities to apply new skills were effective in ensuring good clinical outcomes for women receiving IUD insertion by newly trained providers. Implications Data from this study support recommendations to program managers, policymakers, and clinicians that IUDs can be inserted safely in resource-constrained settings when providers receive appropriate training and support.
Collapse
Affiliation(s)
| | - Valentine Wanga
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Khatija Ahmed
- Setshaba Research Centre, Soshanguve, Gauteng, South Africa
- Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Tsungai Chipato
- University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Peter Gichangi
- International Centre for Reproductive Health, Nyali, Mombasa, Kenya
- University of Nairobi, Nairobi, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Cheryl Louw
- Madibeng Centre for Research, Brits, North West, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Susan Morrison
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Margaret Moss
- Department of O&G, Faculty of Health Sciences, University of Cape Town/Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Nelly R. Mugo
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Melanie Pleaner
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Caitlin W. Scoville
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Katherine K. Thomas
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - for the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium
- FHI 360, Durham, NC, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Setshaba Research Centre, Soshanguve, Gauteng, South Africa
- Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria, Pretoria, Gauteng, South Africa
- University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
- International Centre for Reproductive Health, Nyali, Mombasa, Kenya
- University of Nairobi, Nairobi, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
- Madibeng Centre for Research, Brits, North West, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, Gauteng, South Africa
- Department of O&G, Faculty of Health Sciences, University of Cape Town/Groote Schuur Hospital, Cape Town, Western Cape, South Africa
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| |
Collapse
|
26
|
FSRH Guideline (March 2023) Intrauterine contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:1-142. [PMID: 37188461 DOI: 10.1136/bmjsrh-2023-iuc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
27
|
Heaney C, Lee P, Winer A. Robot-Assisted Removal of a Partially Intravesical Intrauterine Device (IUD) and Large Bladder Stone. Case Rep Urol 2023; 2023:8074689. [PMID: 36742352 PMCID: PMC9897916 DOI: 10.1155/2023/8074689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/26/2022] [Accepted: 12/10/2022] [Indexed: 01/29/2023] Open
Abstract
An intrauterine device (IUD) is a highly effective and widely utilized option for long-acting reversible contraception. IUDs are generally well-tolerated with a low rate of serious complications. Perforation of an IUD through the uterine wall and into the urinary bladder is a rare event that may be asymptomatic. The approach for surgical removal primarily depends on the location of the device. We present a case report of a 41-year-old woman who was found to have a partially intravesical IUD and associated 2.4 cm bladder calculus. Removal of the intravesical IUD and stone was achieved with cystoscopy, cystolitholapaxy, and robot-assisted laparoscopic cystotomy.
Collapse
Affiliation(s)
- Cassandra Heaney
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Paul Lee
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Andrew Winer
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| |
Collapse
|
28
|
Koh AS. Neglected Intrauterine Device Migration Complications: Case Reports. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:11-18. [PMID: 36727094 PMCID: PMC9883666 DOI: 10.1089/whr.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 02/03/2023]
Abstract
This series of four cases describes unusual intrauterine device (IUD) migration complications, associated etiologic factors, and their management. Recent increases in sociopolitical and medical forces worldwide contributed to inattention to these patients with subclinical IUD complications. The international movement of patients, delays in gynecologic care due to the COVID-19 pandemic, lack of health care access, shifts away from annual examinations, and patients' lack of medical records or IUD awareness can lead to long durations of neglected IUDs and associated complications. These complications might have been avoided or minimized with regular gynecologic health care. Physicians should consider moving toward routine examinations of all IUD patients, rather than away from annual examinations as has been promulgated by some medical societies. Patient education is needed on the importance of routine monitoring of IUDs and retention of device records. Clinicians should become familiar with IUDs from around the world as well as devices no longer being prescribed, as their appearance, associated complications, and presentations may differ from locally currently available devices.
Collapse
Affiliation(s)
- Audrey S. Koh
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA.,Address correspondence to: Audrey S. Koh, MD, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, 2100 Webster Street, Suite 518, San Francisco, CA 94115, USA.
| |
Collapse
|
29
|
Zorilă GL, Căpitănescu RG, Drăgușin RC, Istrate-Ofițeru AM, Bernad E, Dobie M, Bernad S, Craina M, Ceaușu I, Marinaş MC, Comănescu MC, Zorilă MV, Drocaș I, Berbecaru EIA, Iliescu DG. Uterine Perforation as a Complication of the Intrauterine Procedures Causing Omentum Incarceration: A Review. Diagnostics (Basel) 2023; 13:diagnostics13020331. [PMID: 36673141 PMCID: PMC9858542 DOI: 10.3390/diagnostics13020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Omentum involvement resulting from uterine perforation is a rare complication following intrauterine procedures that might require immediate intervention due to severe ischemic consequences. This review examines the prevalence of this complication, risk factors, the mode and timing of diagnosis, the proper management and the outcome. METHODS A systematic literature search was conducted on PubMed, PubMed Central and Scopus using uterine perforation, D&C, abortion and omentum as keywords. The exclusion criteria included the presence of the uterus or placenta's malignancy and uterine perforation following delivery or caused by an intrauterine device. RESULTS The review included 11 articles from 133 screened papers. We identified 12 cases that three evaluators further analysed. We also present the case of a 32-year-old woman diagnosed with uterine perforation and omentum involvement. The patient underwent a hysteroscopic procedure with resectioning the protruding omentum into the uterine cavity, followed by intrauterine device insertion. CONCLUSION This paper highlights the importance of a comprehensive gynaecological evaluation following a D&C procedure that includes a thorough clinical examination and a detailed ultrasound assessment. Healthcare providers should not overlook the diagnosis of omentum involvement in the presence of a history of intrauterine procedures.
Collapse
Affiliation(s)
- George Lucian Zorilă
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
| | - Răzvan Grigoraș Căpitănescu
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
| | - Roxana Cristina Drăgușin
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
| | - Anca-Maria Istrate-Ofițeru
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Histology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
- Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Elena Bernad
- Department of Obstetrics and Gynaecology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square no 2, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynaecology, “PiusBrinzeu” County Emergency Hospital, 300723 Timisoara, Romania
- Correspondence:
| | - Mădălina Dobie
- Lugoj Municipal Council, Medical Assistance-Education Service Romania, 305500 Lugoj, Romania
| | - Sandor Bernad
- Romanian Academy Timisoara Branch, Mihai Viteazul Avenue, 24, 300275 Timisoara, Romania
| | - Marius Craina
- Department of Obstetrics and Gynaecology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square no 2, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynaecology, “PiusBrinzeu” County Emergency Hospital, 300723 Timisoara, Romania
| | - Iuliana Ceaușu
- Department of Obstetrics and Gynaecology, “Carol Davila” University of Medicine and Pharmacy, “Dr I. Cantacuzno” Hospital, 020021 Bucharest, Romania
| | - Marius Cristian Marinaş
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Maria-Cristina Comănescu
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Marian Valentin Zorilă
- Department of Forensic Medicine, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Ileana Drocaș
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Elena Iuliana Anamaria Berbecaru
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Dominic Gabriel Iliescu
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, University Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynaecology, Medgin, GINECHO Clinic, 200333 Craiova, Romania
| |
Collapse
|
30
|
Simarmata M, Gurusinga R, Lubis B, Manalu E, Marbun RT, Nainggolan R. The Factors That Influence Women's Desire in using Intrauterine Devices: A Cross-Sectional Observational Study. APOLLO MEDICINE 2023. [DOI: 10.4103/am.am_146_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
|
31
|
Mugino M, MacDermid E, Morgan MJ, Langan R. Long-term sequelae of a misplaced intrauterine contraceptive device. ANZ J Surg 2022; 92:3385-3386. [PMID: 35485444 PMCID: PMC10084242 DOI: 10.1111/ans.17724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/02/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Miho Mugino
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ewan MacDermid
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew J Morgan
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Rinky Langan
- NSW Health Pathology, Sydney, New South Wales, Australia
| |
Collapse
|
32
|
Roman JD. Uterine Perforation by Levonorgestrel-Releasing Intrauterine Device: A Case Report. Cureus 2022; 14:e31398. [DOI: 10.7759/cureus.31398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/14/2022] Open
|
33
|
Long-Acting Reversible Contraception. Obstet Gynecol 2022; 140:883-897. [DOI: 10.1097/aog.0000000000004967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
|
34
|
Maree G, Mohammad S, Saleh R, Hoshma A, Makhluf H. Appendiceal perforation caused by an intrauterine contraceptive device: A case report. Case Rep Womens Health 2022; 36:e00447. [PMID: 36091493 PMCID: PMC9450158 DOI: 10.1016/j.crwh.2022.e00447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022] Open
Abstract
Perforation of the appendix by an intrauterine contraceptive device occurs rarely. A 30-year-old woman presented to the emergency room complaining of severe abdominal pain and nausea 3 months after insertion of an intrauterine contraceptive device (Copper T). Ultrasound and radiological examination showed the device to be outside the uterus, in the right iliac fossa. Adhesions were found at laparoscopy between the appendix and the right adnexa. Appendicectomy, removal of the intrauterine device, and right salpingo-oophorectomy were performed. She was discharged home without any complications. Histopathology revealed inflammation of the appendix. Uterine perforation should be considered in women with abdominal pain following insertion of an intrauterine device. Perforation of the appendix by an intrauterine contraceptive device is rare. The case report describes the management of perforation with an intrauterine contraceptive device (Copper T) The device was located with plain x-rays and ultrasonography. The device was removed laparoscopically.
Collapse
Affiliation(s)
- Gulan Maree
- Department of Pediatric surgery, Tishreen University Hospital, Lattakia, Syria
- Corresponding author at: Pediatric Surgery Department, Tishreen University Hospital, Lattakia, Syria.
| | - Sozan Mohammad
- Department of Obstetrics and Gynecology, Maternity Children's Hospital, Lattakia, Syria
| | - Rama Saleh
- Department of Obstetrics and Gynecology, Maternity Children's Hospital, Lattakia, Syria
| | - Alifa Hoshma
- Department of Obstetrics and Gynecology, Maternity Children's Hospital, Lattakia, Syria
| | - Hawazen Makhluf
- Department of Obstetrics and Gynecology, Maternity Children's Hospital, Lattakia, Syria
| |
Collapse
|
35
|
Boushehry R, Al-Taweel T, Bandar A, Hasan M, Atnuos M, Alkhamis A. Rare case of rectal perforation by an intrauterine device: Case report and review of the literature. Int J Surg Case Rep 2022; 99:107610. [PMID: 36116303 PMCID: PMC9568710 DOI: 10.1016/j.ijscr.2022.107610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Intrauterine devices (IUDs) are safe, highly effective and reversible forms of contraception. Reliance on IUD has been increasing and as such, it is the responsibility of the healthcare provider to be aware of the complications associated with it. IUD rectal migration is one of the rare but serious complications that may lead to detrimental sequelae. CASE PRESENTATION A 30-year-old asymptomatic woman presented to the gynaecology clinic two months after a difficult insertion of an IUD. On examination, the device was not localised in utero with transvaginal sonography. Computed tomography scan and colonoscopy revealed the position of the IUD within the rectum. It was successfully retrieved with a combined laparoscopic-colonoscopic approach. Follow-up flexible sigmoidoscopy showed a well-healed rectal wall. CLINICAL DISCUSSION IUD perforation can increase the risk of morbidity and necessitates early surgical intervention even if the patient is asymptomatic. Combined laparoscopic-colonoscopic approach allows for safe retrieval of IUD that has perforated the intraperitoneal rectal segment or is firmly embedded within the mucosa. Recognising the risk factors and adhering to the principles of IUD insertion could significantly lower the risk of perforation. CONCLUSION This case report highlights the importance of a physician's vigilance regarding a perforating IUD in a patient with a history of a difficult insertion. It is imperative to undertake additional steps to rule out such a complication in these cases. Uterine perforation can be avoided with implementation of safe IUD insertion practice.
Collapse
Affiliation(s)
| | - Talal Al-Taweel
- Division of Gastroenterology, Department of Internal Medicine, Jaber Al-Ahmad Hospital, Kuwait
| | - Asya Bandar
- Obstetrics and Gynaecology Department, Jaber Al-Ahmad Hospital, Kuwait
| | - Maryam Hasan
- Division of Gastroenterology, Department of Internal Medicine, Jaber Al-Ahmad Hospital, Kuwait
| | - Mario Atnuos
- Department of Surgery, Jaber Al-Ahmad Hospital, Kuwait
| | - Ahmed Alkhamis
- Department of Surgery, Jaber Al-Ahmad Hospital, Kuwait; Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait
| |
Collapse
|
36
|
Alharbi KY, Filimban HA, Bafageeh SW, Binaqeel AS, Bayzid MA, Brasha NM. Removal of a Migrated Intrauterine Contraceptive Device Perforating the Terminal Ileum: A Case Report. Cureus 2022; 14:e29748. [PMID: 36340548 PMCID: PMC9621717 DOI: 10.7759/cureus.29748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
We aim to present a rare case of a missing intrauterine contraceptive device (IUCD) that was found in the terminal ileum by laparoscopy and was managed initially by laparoscopy and then proceeded to laparotomy. A 29-year-old female who had a copper IUCD inserted by a senior gynecologist presented to the clinic with pelvic pain and discomfort. She underwent laparoscopy for IUCD removal. Intraoperatively, the IUCD was discovered to be embedded in the terminal ileum, and therefore, laparoscopy was converted to an open laparotomy. The patient was readmitted multiple times because of abnormal fluid collection in the pelvic region, which was resolved finally by pigtail insertion. This case sheds a light on the possibility of complications occurring in the medical field even if the practitioner is a senior gynecologist. Furthermore, missed IUCDs require thorough investigation and imaging to make an appropriate management plan to avoid serious complications.
Collapse
|
37
|
Mitranovici MI, Chiorean DM, Sabău AH, Cocuz IG, Tinca AC, Mărginean MC, Popelea MC, Irimia T, Moraru R, Mărginean C, Craina ML, Petre I, Bernad ES, Petre I, Cotoi OS. An Interesting Image of Transmural Migration of a Levonorgestrel-Releasing Intrauterine Device (LNg-IUD). Diagnostics (Basel) 2022; 12:diagnostics12092227. [PMID: 36140629 PMCID: PMC9498182 DOI: 10.3390/diagnostics12092227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
Intrauterine devices (IUDs) are very common as a method of birth control. By adding progesterone (levonorgestrel), a decrease in the risk of complications has been documented, including the risk of perforation. Even though only a few complications have been described, adjacent organs may be involved in the case of migration—a life-threatening situation. A 45-year-old G4P2 woman was seen in our clinic for LNg-IUD removal, according to the medical instructions. Her main complaints were abdominal discomfort, low back pain, and recurrent menorrhagia. A “lost” IUD was initially suspected; the patient confirmed the detection and removal of the control strings, and a subsequent discussion related to delayed transmural migration of the IUD being followed. The ultrasonography revealed the migration of the IUD to the uterine cervix and size-decreased uterine fibroids, confirming the effectiveness of the LNg-IUD. The MRI and ultrasonography being useless, a subsequent X-ray and CT scan were requested, both confirming a myometrium-positioned IUD, adjacent to the serosa and lumbosacral plexus. Even though the IUD is considered a safe device with reversible effect, it can be associated with severe morbidity, with an ultrasound follow-up being required. For more precise detection of the IUD, we strongly recommend an X-ray or CT scan examination, followed by safe removal.
Collapse
Affiliation(s)
- Melinda-Ildiko Mitranovici
- Department of Obstetrics and Gynecology, Emergency County Hospital Hunedoara, 14 Victoriei Street, 331057 Hunedoara, Romania
- Correspondence:
| | - Diana Maria Chiorean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
| | - Adrian-Horațiu Sabău
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| | - Iuliu-Gabriel Cocuz
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| | - Andreea Cătălina Tinca
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| | - Mihaela Cornelia Mărginean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| | - Maria Cătălina Popelea
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
| | - Traian Irimia
- School of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Raluca Moraru
- Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Claudiu Mărginean
- Department of Obstetrics and Gynecology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Marius Lucian Craina
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq, 300041 Timisoara, Romania
| | - Izabella Petre
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq, 300041 Timisoara, Romania
| | - Elena Silvia Bernad
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq, 300041 Timisoara, Romania
| | - Ion Petre
- Department of Medical Informatics and Biostatistics, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq, 300041 Timisoara, Romania
| | - Ovidiu Simion Cotoi
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| |
Collapse
|
38
|
Salih MA, Tefera AT, Gebrehiwot FG, Mideksa AG, Halala NS, Gebreselassie KH. Gross Hematuria Caused by Intravesical Migration of a Forgotten Intrauterine Device: A Case Report and Literature Review. Res Rep Urol 2022; 14:291-296. [PMID: 36060306 PMCID: PMC9432567 DOI: 10.2147/rru.s364889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Intrauterine device (IUD) is the second most widely used method of contraception worldwide. Up to 14% women prefer IUD for its attractive advantages such as cost effectiveness, high efficiency, and low complication rate. Despite these advantages, however, some complications may occur. One of these complications is uterine perforation and migration of the device to involve adjacent viscera such as peritoneum, bowel, vessels, and rarely bladder. IUD migration into the urinary bladder is uncommon, and only 70 cases are reported in the literature. Recurrent urinary tract infection and bladder calculi are the commonest presentations, and, rarely, women can present with gross hematuria. A high index of suspicion is needed in the evaluation of women who report pregnancy after IUD insertion as it might be the first clue to suspect migration. A forgotten and long-standing IUD increases the risk of uterine perforation and migration. A routine abdominal radiography, cystoscopy, and transvaginal ultrasonography are diagnostic. A computed tomography can also be employed in selected cases to delineate anatomic relations. Urologists should consider a vesical foreign body such as migrated IUD in women with recurrent lower urinary infections. Gross hematuria in a young woman should alert the urologist, and the evaluation should address a detailed contraceptive history. Every migrated IUD should be removed via endoscopy, laparoscopy, or open surgery. Proper follow-up and education of women before and after IUD insertion is also recommended to pick up on complications in time. Here, we report the successful open surgical treatment of a woman who had a forgotten IUD for 15 years and ultimately presented with gross hematuria due to trans-vesical migration. As to our literature search, there was no similar case reported from a urology center from Ethiopia.
Collapse
Affiliation(s)
- Mohammed Abdulaziz Salih
- Urology Unit, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Alemayehu Tegegne Tefera
- Urology Unit, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Adugna Getachew Mideksa
- Urology Unit, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Nebiyou Samuel Halala
- Urology Unit, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kaleab Habtemichael Gebreselassie
- Urology Unit, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Correspondence: Kaleab Habtemichael Gebreselassie, Urology Unit, Department of Surgery, St. Paul’s Hospital Millennium Medical College (SPHMMC), Swaziland Street, Addis Ababa, Ethiopia, Tel +251 913632425, Email ;
| |
Collapse
|
39
|
Schwarzman P, Baumfeld Y, Mastrolia SA, Yaniv-Salem S, Leron E, Silberstein T. Obstetric Outcomes after Perforation of Uterine Cavity. J Clin Med 2022; 11:jcm11154439. [PMID: 35956056 PMCID: PMC9369682 DOI: 10.3390/jcm11154439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
We aimed to evaluate the pregnancy characteristics and obstetric outcomes in patients after perforation of the uterus. Study design: A retrospective cohort study was conducted and included all patients who were diagnosed with uterine perforation and treated in a tertiary referral medical center between the years 1996 and 2018. Up to two deliveries after perforations were investigated. Results: During the study period, 51 women were diagnosed with uterine perforation during gynecological procedures, including intrauterine device (IUD) insertion. The mean age of patients at the time of diagnosis was 27.9 (±4.7) years. The majority, 76.5% (n = 39), experienced perforation during IUD insertion, and 23.5% (n = 12) of the patients experienced perforation during surgical procedures. Most of the patients were multiparous or grand multiparous, 45.8. % (n = 22) and 39.6% (n = 19) respectively. Anteflexed uterus was found in 86.4% of the patients (n = 38). Five patients (9.8%) had pelvic abscesses after the IUD insertion. A total of 50 patients had 71 deliveries subsequent to uterine perforation. One patient experienced intrauterine fetal death due to fetal malformations. One patient experienced uterine rupture. No other major obstetric complications were noted. Conclusions: Uterine perforation may be associated with adverse obstetric outcomes. The possibility of uterine rupture must be considered while managing the deliveries of patients after uterine perforation. Moreover, a larger cohort and further studies are needed to establish an association between uterine perforation and adverse outcomes of the subsequent deliveries.
Collapse
Affiliation(s)
- Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
- Clinical Research Center, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
- Department of Obstetrics and Gynecology, Ospedale Civile Umberto I, Via Ruvo, 108, 70033 Corato, Italy
- Correspondence:
| | - Shimrit Yaniv-Salem
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| | - Elad Leron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| | - Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| |
Collapse
|
40
|
Gabriel L, Ederhof L, Fellmann U, Meili G. Surgical uterus-preserving therapy after uterine rupture and haemorrhage due to placenta percreta in the first trimester following embolisation of the uterine arteries and B-Lynch suture in a previous pregnancy. BMJ Case Rep 2022; 15:e250247. [PMID: 35798499 PMCID: PMC9263935 DOI: 10.1136/bcr-2022-250247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/04/2022] Open
Abstract
A woman in her early 30s in the 11 2/7 week of pregnancy was admitted with severe abdominal pain and emesis. One year prior, the patient had undergone hysteroscopic adhesiolysis to treat Asherman syndrome resulting from a prior pregnancy. Examination of the patient revealed a haemoperitoneum and an intact intrauterine pregnancy. Laparoscopic adhesiolysis and haemostasis was performed and the patient was transferred to the intensive care unit. Subsequent examination due to persistent abdominal pain revealed an occult iatrogenic perforation of the uterus and placenta percreta with spontaneous uterine rupture. Although treatment for placenta percreta has generally been hysterectomy, in this case, the rupture and perforation sites were resected, representing successful fertility preserving management for this oft-overlooked pregnancy complication.
Collapse
Affiliation(s)
- Laura Gabriel
- Gynecology/Obstetrics, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Louisa Ederhof
- Gynecology/Obstetrics, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Ursula Fellmann
- Gynecology/Obstetrics, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Gesine Meili
- Gynecology/Obstetrics, Kantonsspital Winterthur, Winterthur, Switzerland
| |
Collapse
|
41
|
Bach S, Heavey E. How NPs can eliminate practice barriers to intrauterine device use. Nurse Pract 2022; 47:22-30. [PMID: 35470331 DOI: 10.1097/01.npr.0000827120.41973.df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT Barriers to intrauterine device use include cost, absence of qualified providers, the lack of simplified insertion protocols, cultural hesitation, and misconceptions of appropriateness of use. This article outlines how NPs can eliminate practice barriers to intrauterine device use and prevent unintended pregnancy.
Collapse
|
42
|
Tarafdari A, Malek M, Pahlevan Falahy E, Hadizadeh A. IUD perforation and embedment within omentum: A rare and perplexing incidence. Clin Case Rep 2022; 10:e05732. [PMID: 35441023 PMCID: PMC9010853 DOI: 10.1002/ccr3.5732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 01/22/2023] Open
Abstract
Intrauterine devices rarely fail, which results in pregnancy. Meanwhile, these devices can perforate uterine and migrate through abdomen. Our case experienced IUD failure and perforation simultaneously, and the device was embedded in omentum and shifted rapidly, which made it hard to localize and could only be removed using ultrasonography guidance.
Collapse
Affiliation(s)
- Azadeh Tarafdari
- Department of Obstetrics and Gynecology Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Mahrooz Malek
- Department of Radiology Medical Imaging Center Advanced Diagnostic and Interventional Radiology Tehran Iran
| | - Elaheh Pahlevan Falahy
- Department of Obstetrics and Gynecology Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Alireza Hadizadeh
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| |
Collapse
|
43
|
Khiangte E, Khiangte I, Naiding N, Deka K, Bathari R, Doungel J. A rendezvous technique using laparoscopy and cystoscopy to remove transmigrated intrauterine contraceptive device from abdomen and urinary bladder. J Minim Access Surg 2022; 18:613-615. [DOI: 10.4103/jmas.jmas_216_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
44
|
Unusual cause of low abdominal pain. Acta Gastroenterol Belg 2021; 84:685. [PMID: 34965058 DOI: 10.51821/84.4.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 53-year-old woman, G2P2, was referred to the outpatient clinic because of chronic abdominal pain. Abdominal examination revealed tenderness in the right lower quadrant without peritoneal signs and blood analysis was normal. To exclude slow transit constipation a pellet study was performed: plain abdominal radio-graphy showed the presence of all ingested pellets and an abnormal, slightly lateralized and angulated position of the intrauterine device, a levonorgestrel intrauterine system called Mirena® which was placed five years earlier (figure 1). Subsequently an abdominal computed tomography was executed.
Collapse
|
45
|
Imaging evaluation of uterine perforation and rupture. Abdom Radiol (NY) 2021; 46:4946-4966. [PMID: 34129055 DOI: 10.1007/s00261-021-03171-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022]
Abstract
Uterine perforation and rupture, denoting iatrogenic and non-iatrogenic uterine wall injury, respectively, are associated with substantial morbidity,and at times mortality. Diverse conditions can result in injury to both the gravid and the non-gravid uterus, and imaging plays a central role in diagnosis of such suspected cases. Ultrasound (US) is the initial imaging modality of choice, depicting the secondary signs associated with uterine wall injury and occasionally revealing the site of perforation. Computed tomography can be selectively used to complement US findings, to provide a more comprehensive picture, and to investigate complications beyond the reach of US, such as bowel injury. In certain scenarios, magnetic resonance imaging can be an important problem-solving tool as well. Finally, catheter angiography is a valuable tool with both diagnostic and therapeutic capability, with potential for fertility preservation. In this manuscript, we will highlight the clinical and imaging approach to uterine perforation and rupture, while emphasizing the value of various imaging modalities in this context. In addition, we will review the multi-modality imaging features of uterine perforation and rupture and will address the role of the radiologist as a crucial member of the management team. Finally, a summary diagrammatic depiction of imaging approach to patients presenting with uterine perforation or rupture is provided.
Collapse
|
46
|
Wale J, Rowlands S. The ethics of state-sponsored and clinical promotion of long-acting reversible contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:e11. [PMID: 32546578 DOI: 10.1136/bmjsrh-2020-200630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To review ethical aspects of the promotion and provision of long-acting reversible contraception (LARC). Specifically, to examine (1) the tension between informational exchange and the active promotion of LARC methods to new and existing contraceptive users by healthcare professionals; and (2) the distinct ethical issues arising from the promotion of LARC methods by state-sponsored actors and healthcare professionals. METHODS Narrative review and ethical analysis. FINDINGS There is an ethical difference between raising awareness/informational provision and actively promoting or prioritising specific contraceptive methods. It matters whether the policy choice is made, or the promotional activity about contraception is undertaken, by individual healthcare professionals at a local level or by more remote state-sponsored actors, because the relationship between the promoter and the (potential) contraceptive user is of a different kind. Imposing a dual responsibility upon healthcare professionals for raising awareness/informational exchange and the active promotion of LARC creates an unnecessary tension and barrier for the delivery of patient-centred care. CONCLUSIONS This review highlights the need for ethical reflection on the central role of the promoting agent and the distinction between facilitating informational awareness and active promotion of LARC. LARC methods should not be prioritised in isolation and without regard to the wider implications of public promotion. A balanced narrative and information-sharing programme that respects the individual interests of each contraceptive user is called for, especially in direct professional/service user relationships. No assumption should be made that user decision-making will necessarily be determined and influenced solely by the relative effectiveness of the contraceptive method.
Collapse
Affiliation(s)
- Jeffrey Wale
- Department of Humanities and Law, Bournemouth University, Poole, UK
| | - Sam Rowlands
- Department of Medical Sciences and Public Health, Bournemouth University, Bournemouth, UK
| |
Collapse
|
47
|
Zamani Bonab M, Anvari Aliabad R, Alimohammadi S. Migration of intrauterine device caused asymptomatic acute appendicitis: A case report. Clin Case Rep 2021; 9:e04283. [PMID: 34084522 PMCID: PMC8143274 DOI: 10.1002/ccr3.4283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/20/2021] [Accepted: 04/20/2021] [Indexed: 01/01/2023] Open
Abstract
Missing of IUD is not always due to expulsion. If the patient is sure that it has not got expulsed, further investigations such as abdominal ultrasound and X-ray should be performed to look for the device before any device-related complications.
Collapse
Affiliation(s)
- Mehrangiz Zamani Bonab
- Department of GynecologySchool of MedicineHamadan University of Medical SciencesHamadanIran
| | | | - Shohreh Alimohammadi
- Department of GynecologySchool of MedicineHamadan University of Medical SciencesHamadanIran
| |
Collapse
|
48
|
Rasyid N, Nainggolan HJ, Jonardi PA, Raharja PAR, Wiweko B, Atmoko W, Birowo P. Early-onset complete spontaneous migration of contraceptive intrauterine device to the bladder in a post C-section patient: A case report. Int J Surg Case Rep 2021; 82:105850. [PMID: 33838481 PMCID: PMC8056411 DOI: 10.1016/j.ijscr.2021.105850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
Migration of a contraceptive intrauterine device (IUD) rarely occurs. Computed tomography is the preferred radiological examination. Waiting for the complete migration of IUD is beneficial for its easy removal. Periodical evaluation may prevent complications in patients with contraceptive IUD.
Introduction and importance Spontaneous migration of a contraceptive intrauterine device (IUD) to the bladder is very rare. It usually takes years for the IUD to migrate completely from the uterine cavity to the bladder. We report a case of early-onset complete spontaneous migration of contraceptive IUD to the bladder in a post C-section patient. Case presentation A 30-year-old woman presented with suprapubic pain and dysuria three weeks prior to hospitalization. She had C-section three months prior and underwent copper IUD insertion two months after the surgery. One week after IUD insertion, radiography showed that the IUD remained in the uterus, but the patient felt suprapubic pain and dysuria. Computed tomography (CT) three weeks after IUD insertions showed IUD migration to the bladder with its tips embedded in the uterine wall. Cystoscopy was performed one week later and the IUD was completely inside the bladder. By then, the IUD was removed completely via forceps with no complication. Clinical discussion The exact pathophysiology of spontaneous IUD migration is unknown, but migration always starts with uterine perforation. In our case, uterine perforation was probably caused by immediate traumatic perforation. CT is the preferred radiological examination. IUD removal was performed one month after IUD insertion showing complete migration of the IUD, though CT one week prior suggested that the tips of the IUD remained embedded. Conclusion In cases of early-onset complete spontaneous migration of contraceptive IUD to the bladder, CT is the preferred radiological examination, and delaying removal procedure may be beneficial.
Collapse
Affiliation(s)
- Nur Rasyid
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia.
| | - Hoshea Jefferson Nainggolan
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Prinnisa Almanda Jonardi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Putu Angga Risky Raharja
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Budi Wiweko
- Division of Reproductive Endocrinology and Infertility, Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Widi Atmoko
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Ponco Birowo
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| |
Collapse
|
49
|
Makena D, Gichere I, Warfa K. Levonorgestrel intrauterine system embedded within tubal ectopic pregnancy: a case report. J Med Case Rep 2021; 15:107. [PMID: 33685513 PMCID: PMC7941916 DOI: 10.1186/s13256-021-02723-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/09/2021] [Indexed: 01/16/2023] Open
Abstract
Background The presence of the levonorgestrel-releasing intrauterine system embedded within an ectopic pregnancy is a rare occurrence. Tubal migration of an intrauterine device is not well understood and has not been extensively studied in literature. Case presentation A 34-year-old African woman, para 1, gravida 2, presented with symptoms of ruptured ectopic pregnancy. She underwent a laparoscopy where a ruptured left ectopic pregnancy was found with a levonorgestrel-releasing intrauterine system inserted 2 years prior embedded within the tube. A left salpingectomy was performed with removal of the levonorgestrel-releasing intrauterine system. The patient recovered well and proceeded to have an intrauterine pregnancy 3 months later. Conclusion Migration of the levonorgestrel-releasing intrauterine system into the fallopian tube is a rare occurrence that is not well understood. In the case presented, levonorgestrel-releasing intrauterine system was found embedded within the fimbrial end of the left fallopian tube, which had a ruptured ectopic pregnancy. Surgical treatment with laparoscopy is recommended for intraabdominal intrauterine device to prevent complications.
Collapse
Affiliation(s)
- Dorothy Makena
- Department of Obstetrics and Gynecology, Aga Khan University Hospital Nairobi, P.O. Box 30270-00100, Nairobi, Kenya.
| | - Ingrid Gichere
- Department of Obstetrics and Gynecology, Aga Khan University Hospital Nairobi, P.O. Box 30270-00100, Nairobi, Kenya
| | - Khadija Warfa
- Department of Obstetrics and Gynecology, Aga Khan University Hospital Nairobi, P.O. Box 30270-00100, Nairobi, Kenya
| |
Collapse
|
50
|
Tchuenkam LW, Mbonda AN, Tochie JN, Mbem-Ngos PP, Noah-Ndzie HG, Bang GA. Transvaginal strangulated bowel evisceration through uterine perforation due to unsafe abortion: a case report and literature review. BMC WOMENS HEALTH 2021; 21:98. [PMID: 33663467 PMCID: PMC7934394 DOI: 10.1186/s12905-021-01247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/24/2022]
Abstract
Background Induced abortion, whether therapeutic or elective, is a surgical procedure frequently practiced worldwide. It is a significant cause of maternal morbidity and mortality. When the procedure is performed in precarious conditions, by unqualified personnel, it leads to serious consequences, including uterine perforation and its associated lesions. Its management remains a medico-surgical emergency. Case presentation We present two cases of unsafe abortions performed by cervical dilatation and intrauterine curettage which resulted in uterine perforation and intestinal evisceration through the vagina leading to acute intestinal obstruction. Both patients underwent intensive resuscitation followed by an emergency laparotomy. The first case was a 26-year-old woman living in rural Cameroon. Following a procedure of termination of her pregnancy, the patient noted the presence of bowel at the vaginal introitus associated with signs of intestinal obstruction. She was transferred to a specialized center was after 4 days later of the onset of the evisceration. Considering the gangrened eviscerated terminal ileum, a right hemicolectomy with anastomosis was performed, as well as a suture of the uterine perforation. The second patient was an 18-year-old African living as a refugee in Cameroon. She was referred for abdominal pain in the context of intestinal obstruction with a viable jejunal loop extruding through the vagina. A simple jejunal resection was performed with end-to-end anastomosis and suture of the uterine perforation. In both cases, the postoperative course was uneventful. Conclusions Uterine perforation is a serious complication of intrauterine gynecological procedures and instrumental abortion in particular. It can lead to evisceration of the intra-abdominal viscera through the uterine perforation. It is therefore a real surgical emergency with multiple and fatal consequences.
Collapse
Affiliation(s)
| | | | - Joel Noutakdie Tochie
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Patrick P Mbem-Ngos
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Hugues G Noah-Ndzie
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Guy Aristide Bang
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.,Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| |
Collapse
|