Perforated Intraperitoneal Intrauterine Contraceptive Devices: Diagnosis, Management, and Clinical Outcomes

Kimberly A. Kho, Dina J. Chamsy

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Study Objective: To describe a series of intraperitoneal perforated intrauterine contraception devices (IUDs) and to discuss associated findings, methods for diagnosis, and management of this complication. Design: Retrospective review of surgical database between 1998 and 2012 (Canadian Task Force classification II-2). Setting: University medical center. Patients: Thirty-seven women with a perforated IUD in the intraperitoneal cavity. Measurements and Main Results: Nineteen copper IUDs (51%), 17 levonorgestrel-releasing IUDs (LNG-IUDs) (46%), and 1 Lippes loop (3%) were identified. Twenty women (54%) had abdominal pain, 16 (43%) had no symptoms, and 1 (3%) was found to have strings protruding from her anus. Twenty-six women (70%) underwent laparoscopy to remove the IUD, and 6(16%) underwent hysteroscopy along with laparoscopy. Conversion to laparotomy was required in 4 patients (11%). Two IUDs (5%) caused full-thickness rectouterine fistulas that required laparotomy for repair. Dense adhesions were found in 21 women (57%); and of those, 15 (71%) were associated with a copper IUD. Copper IUDs were significantly more likely than LNG-IUDs to be associated with dense adhesions (p=02). Conclusions: Perforated IUDs can be asymptomatic or cause short-term and long-term symptoms. Long-term complications include abscess and fistula formation. Copper IUDs cause a greater inflammatory process than do LNG-IUDs. Even if asymptomatic, we advocate prompt removal of all IUDs that perforate into the peritoneal cavity once they are identified. Laparoscopic surgical removal of an intraperitoneal IUD is a safe and preferred method.

Original languageEnglish (US)
Pages (from-to)596-601
Number of pages6
JournalJournal of Minimally Invasive Gynecology
Volume21
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Intrauterine Devices
Contraception
Copper Intrauterine Devices
Levonorgestrel
Laparoscopy
Laparotomy
Fistula
Hysteroscopy
Peritoneal Cavity
Anal Canal
Advisory Committees
Abscess
Abdominal Pain

Keywords

  • Intra-abdominal
  • Intraperitoneal
  • Laparoscopy
  • Missing IUD
  • Perforated

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Perforated Intraperitoneal Intrauterine Contraceptive Devices : Diagnosis, Management, and Clinical Outcomes. / Kho, Kimberly A.; Chamsy, Dina J.

In: Journal of Minimally Invasive Gynecology, Vol. 21, No. 4, 2014, p. 596-601.

Research output: Contribution to journalArticle

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title = "Perforated Intraperitoneal Intrauterine Contraceptive Devices: Diagnosis, Management, and Clinical Outcomes",
abstract = "Study Objective: To describe a series of intraperitoneal perforated intrauterine contraception devices (IUDs) and to discuss associated findings, methods for diagnosis, and management of this complication. Design: Retrospective review of surgical database between 1998 and 2012 (Canadian Task Force classification II-2). Setting: University medical center. Patients: Thirty-seven women with a perforated IUD in the intraperitoneal cavity. Measurements and Main Results: Nineteen copper IUDs (51{\%}), 17 levonorgestrel-releasing IUDs (LNG-IUDs) (46{\%}), and 1 Lippes loop (3{\%}) were identified. Twenty women (54{\%}) had abdominal pain, 16 (43{\%}) had no symptoms, and 1 (3{\%}) was found to have strings protruding from her anus. Twenty-six women (70{\%}) underwent laparoscopy to remove the IUD, and 6(16{\%}) underwent hysteroscopy along with laparoscopy. Conversion to laparotomy was required in 4 patients (11{\%}). Two IUDs (5{\%}) caused full-thickness rectouterine fistulas that required laparotomy for repair. Dense adhesions were found in 21 women (57{\%}); and of those, 15 (71{\%}) were associated with a copper IUD. Copper IUDs were significantly more likely than LNG-IUDs to be associated with dense adhesions (p=02). Conclusions: Perforated IUDs can be asymptomatic or cause short-term and long-term symptoms. Long-term complications include abscess and fistula formation. Copper IUDs cause a greater inflammatory process than do LNG-IUDs. Even if asymptomatic, we advocate prompt removal of all IUDs that perforate into the peritoneal cavity once they are identified. Laparoscopic surgical removal of an intraperitoneal IUD is a safe and preferred method.",
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N2 - Study Objective: To describe a series of intraperitoneal perforated intrauterine contraception devices (IUDs) and to discuss associated findings, methods for diagnosis, and management of this complication. Design: Retrospective review of surgical database between 1998 and 2012 (Canadian Task Force classification II-2). Setting: University medical center. Patients: Thirty-seven women with a perforated IUD in the intraperitoneal cavity. Measurements and Main Results: Nineteen copper IUDs (51%), 17 levonorgestrel-releasing IUDs (LNG-IUDs) (46%), and 1 Lippes loop (3%) were identified. Twenty women (54%) had abdominal pain, 16 (43%) had no symptoms, and 1 (3%) was found to have strings protruding from her anus. Twenty-six women (70%) underwent laparoscopy to remove the IUD, and 6(16%) underwent hysteroscopy along with laparoscopy. Conversion to laparotomy was required in 4 patients (11%). Two IUDs (5%) caused full-thickness rectouterine fistulas that required laparotomy for repair. Dense adhesions were found in 21 women (57%); and of those, 15 (71%) were associated with a copper IUD. Copper IUDs were significantly more likely than LNG-IUDs to be associated with dense adhesions (p=02). Conclusions: Perforated IUDs can be asymptomatic or cause short-term and long-term symptoms. Long-term complications include abscess and fistula formation. Copper IUDs cause a greater inflammatory process than do LNG-IUDs. Even if asymptomatic, we advocate prompt removal of all IUDs that perforate into the peritoneal cavity once they are identified. Laparoscopic surgical removal of an intraperitoneal IUD is a safe and preferred method.

AB - Study Objective: To describe a series of intraperitoneal perforated intrauterine contraception devices (IUDs) and to discuss associated findings, methods for diagnosis, and management of this complication. Design: Retrospective review of surgical database between 1998 and 2012 (Canadian Task Force classification II-2). Setting: University medical center. Patients: Thirty-seven women with a perforated IUD in the intraperitoneal cavity. Measurements and Main Results: Nineteen copper IUDs (51%), 17 levonorgestrel-releasing IUDs (LNG-IUDs) (46%), and 1 Lippes loop (3%) were identified. Twenty women (54%) had abdominal pain, 16 (43%) had no symptoms, and 1 (3%) was found to have strings protruding from her anus. Twenty-six women (70%) underwent laparoscopy to remove the IUD, and 6(16%) underwent hysteroscopy along with laparoscopy. Conversion to laparotomy was required in 4 patients (11%). Two IUDs (5%) caused full-thickness rectouterine fistulas that required laparotomy for repair. Dense adhesions were found in 21 women (57%); and of those, 15 (71%) were associated with a copper IUD. Copper IUDs were significantly more likely than LNG-IUDs to be associated with dense adhesions (p=02). Conclusions: Perforated IUDs can be asymptomatic or cause short-term and long-term symptoms. Long-term complications include abscess and fistula formation. Copper IUDs cause a greater inflammatory process than do LNG-IUDs. Even if asymptomatic, we advocate prompt removal of all IUDs that perforate into the peritoneal cavity once they are identified. Laparoscopic surgical removal of an intraperitoneal IUD is a safe and preferred method.

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