30. Peritonitis due to perforation of the uterus after intrauterine device removal in menopause women: A rare clinical case report
Main Article Content
Abstract
Uterine perforation due to migratory intrauterine device (IUD) is a rare complication with a rate of 0.01% that can cause damage to surrounding organs such as the bowel and bladder.
We report a 69-year-old female patient with a 30-year history of IUD insertion who was admitted to the hospital with persistent lower abdominal pain and abnormal vaginal bleeding after unsuccessful IUD removal. Physical examination revealed abdominal tenderness, mild distension, and a guarding sign. The computerized tomography showed the image of a uterine fundus perforation by the IUD with abdominal free air and fluid. The diagnosis was peritonitis after IUD removal, and the patient was indicated for emergency partial hysterectomy and small bowel perforation suture. After 6 days of surgery, the patient was diagnosed with recurrent bowel
perforation and was indicated for the second emergency surgery for ileostomy. After 10 days of the second surgery, the patient was discharged from the hospital in stable condition. Conclusion: it is difficult to remove an IUD left in the uterus for a long time. In cases where it cannot be removed, close clinical monitoring, hysteroscopy, or active hysterectomy is recommended.
Article Details
Keywords
Intrauterine device, uterine perforation, bowel perforation, peritonitis, menopause
References
2. Anthony MS, Armstrong MA, Getahun D, et al. Identification and validation of uterine perforation, intrauterine device expulsion, and breastfeeding in four health care systems with electronic health records. Clin Epidemiol. 2019;11:635-643.
3. Roman JD. Uterine Perforation by Levonorgestrel-Releasing Intrauterine Device: A Case Report. Cureus. 2022;14(11):e31398.
4. Heinemann K, Barnett C, Reed S, et al. IUD use among parous women and risk of uterine perforation: A secondary analysis. Contraception. 2017;95(6):605-607.
5. Sinha M, Rani R, Gupta R, et al. Lippes Loop Inserted 45 Years Back: The Dilemma to Remove It or Leave It in situ. A Case Report with Review of Literature. J Clin Diagn Res. 2015;9(4):QE01-05.
6. Kaislasuo J, Suhonen S, Gissler M, et al. Intrauterine contraception: incidence and factors associated with uterine perforation--a population-based study. Hum Reprod. 2012;27(9):2658-2663.
7. Barnett C, Moehner S, Do Minh T, et al. Perforation risk and intra-uterine devices: results of the EURAS-IUD 5-year extension study. Eur J Contracept Reprod Health Care. 2017;22(6):424-428.
8. Sun X, Xue M, Deng X, et al. Clinical characteristic and intraoperative findings of uterine perforation patients in using of intrauterine devices (IUDs). Gynecol Surg. 2018;15(1):3.
9. Rowlands S, Oloto E, Horwell DH. Intrauterine devices and risk of uterine perforation: current perspectives. Open Access J Contracept. 2016;7:19-32.
10. Howard B, Grubb E, Lage MJ, et al. Trends in use of and complications from intrauterine contraceptive devices and tubal ligation or occlusion. Reprod Health. 2017;14(1):70.
11. Elahi N, Koukab H. Diagnosis and management of lost intrauterine contraceptive device. J Pak Med Assoc. 2002;52(1):18-20.
12. Marchi NM, Castro S, Hidalgo MM, et al. Management of missing strings in users of intrauterine contraceptives. Contraception. 2012;86(4):354-358.
13. Gill RS, Mok D, Hudson M, et al. Laparoscopic removal of an intra-abdominal intrauterine device: Case and systematic review. Contraception. 2012;85(1):15-18.
14. Ozgun MT, Batukan C, Serin IS, et al. Surgical management of intra-abdominal mislocated intrauterine devices. Contraception. 2007;75(2):96-100.
15. Prine L, Shah M. Long-Acting Reversible Contraception: Difficult Insertions and Removals. Am Fam Physician. 2018;98(5):304-309.
16. Wang N, Sun H. Uterine Artery Rupture Caused by IUD Extraction: A Case Report. Int J Womens Health. 2022;14:831-836.
17. Guyton KL, Hyman NH, Alverdy JC. Prevention of Perioperative Anastomotic Healing Complications: Anastomotic Stricture and Anastomotic Leak. Adv Surg. 2016;50(1):129-141.