Case reportUterine perforation with Lippes loop intrauterine device-associated actinomycosis a case report and review of the literature
Introduction
Intrauterine devices (IUDs) are a widely used, highly effective, and reversible contraceptive method. Insertion of an IUD is one of the most commonly performed procedures in gynecologic practice. Uterine perforation is one of the most serious complications associated with insertion of an IUD. The incidence is between 0 and 13 per 1000 insertions.1, 2, 3, 4, 5, 6 This varies according to the device used, the operator’s experience, the thoroughness of follow-up, the position of the uterus, and the time-span between delivery and insertion.1, 2 There have been reports about actinomycotic colonization and infection associated with IUDs7, 8 but there have been no reports about perforation of the uterus due to intrauterine device-associated actinomycosis in the world English literature. Herein, we report a case of uterine perforation in a postmenopausal woman with prolonged use of the Lippes loop IUD, who presented with an acute abdomen. We also have included a review of the literature.
Section snippets
Case report
A 67-year-old, gravida 2, para 2, Thai woman came to the emergency room of King Chulalongkorn Memorial Hospital with epigastric abdominal pain having persisted for 1 day. She had used a nonsteroidal inflammatory drug 7 days before. She had been in menopause for 22 years. A Lippes loop IUD had been inserted 35 years previously. She never had any pelvic examination nor Papanicolaou smear for 35 years, but she had no history of pelvic inflammatory disease or any sexually transmitted disease. Her
Discussion
Perforation of the uterus is one of the most serious complications associated with IUD insertion. The incidence has been estimated to range from 0 to 13 perforations per 1000 insertions.1, 2, 3, 4, 5, 6 If the IUD perforates outside the uterus, it can cause complications. Eighty-five percent of perforations do not affect other organs, but the remaining 15% lead to complications in the adjacent visceral organs, most often the intestines.9 IUD complications include bowel obstruction, bowel
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Laparoscopic removal of an intra-abdominal intrauterine device: Case and systematic review
2012, ContraceptionCitation Excerpt :Markovitch et al. [12] also suggest that removal of the perforated IUD may not be necessary. They suggest that adhesion formation following uterine perforation by the IUD tends to occur in localized area [20,21]. Therefore, the IUD should not migrate further and potentially remain asymptomatic.
Bladder perforation related to intrauterine device
2008, Journal of the Chinese Medical AssociationSurgical management of intra-abdominal mislocated intrauterine devices
2007, ContraceptionCitation Excerpt :In our series, 20% of cases were complicated with abscess formation, which was treated with drainage and systemic antibiotics. Intra-abdominal actinomycotic infection related to a mislocated IUD was also reported [19]. Third, many patients will feel anxious after a diagnosis of a foreign object in their abdomen, which may lead to medicolegal problems.
Laparoscopic Management of a Translocated Intrauterine Device Perforating the Bowel
2003, Journal of the American Association of Gynecologic LaparoscopistsExtrauterine mislocated IUD: Is surgical removal mandatory?
2002, ContraceptionLaparoscopic retrieval of perforated intrauterine devices at University Hospital, Jamaica
2002, Journal of the American Association of Gynecologic Laparoscopists