Elsevier

Contraception

Volume 61, Issue 5, May 2000, Pages 347-350
Contraception

Case report
Uterine perforation with Lippes loop intrauterine device-associated actinomycosis a case report and review of the literature

https://doi.org/10.1016/S0010-7824(00)00112-8Get rights and content

Abstract

A case of a 67-year-old postmenopausal woman, gravida 2, para 2, with an uterine perforation from actinomycotic infection with Lippes loop IUD is reported. She had the Lippes loop IUD inserted for 35 years, and had never had any pelvic examination nor Papanicolaou smear. She presented with acute abdominal pain. The clinical picture mimicked peptic ulcer perforation. The woman underwent laparotomy and exudative fluid was discovered in the abdominal cavity with the tip of the Lippes loop IUD at one of the two small holes of the uterine fundus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The postoperative microscopic pathological report demonstrated characteristics of actinomycosis. She was treated with parenteral high-dose penicillin for 4 weeks followed by oral penicillin for 6 months. The woman had an uneventful recovery. To our knowledge, this is the first case report of uterine perforation due to Lippes loop IUD-associated actinomycotic infection.

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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