Images in Gynecologic Surgery
Laparoscopic Management of an Unusual Intrauterine Device Perforation After Postplacental Insertion Lauren Owens, MD, MPH*, Adi Rattner, AB, Anne Burke, MD, MPH, and Tola Fashokun, MD From the Department of Gynecology and Obstetrics, Johns Hopkins Hospital (Dr. Owens), Johns Hopkins University School of Medicine (Ms. Rattner and Dr. Fashokun), and Department of Gynecology and Obstetrics, Johns Hopkins Bayview (Dr. Burke), Baltimore, MD.
DISCUSS
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A 36-year-old woman (gravida 5, para 4014) underwent term vaginal delivery and postplacental intrauterine device (IUD) placement. On postpartum day 13, she presented with abdominal pain, leukocytosis (15.86 ! 103/mm3), and peritoneal signs. An abdominal x-ray showed a perforated IUD (Fig. 1). During laparoscopy, the outer sheath of the IUD inserter was found to have perforated the uterus Fig. 1 Preoperative abdominal x-ray with retained sheath. The arrow indicates the inserter sheath with retained intrauterine device.
(Fig. 2). The IUD and inserter sheath were sequentially removed through the vagina under laparoscopic visualization. The patient’s pain improved postoperatively, and she was discharged on postoperative day 2. Although uterine perforation is a known complication of IUD insertion with an incidence of 0.4 of 1000 women, this is the first reported case of uterine perforation by a retained IUD inserter [1]. Extrauterine IUDs must be removed because of the potential of damage to nearby organs [2]. In 179 cases of IUD perforation, 64.2% of IUDs were removed laparoscopically [3]. Adhesions and bowel perforation are associated with conversion to laparotomy. Fig. 2 Intraoperative photograph of perforation. Upon anteverting the uterus, the intrauterine device (IUD) sheath perforating the fundus was found immediately. The IUD is still within the sheath in this photography.
Corresponding author: Lauren Owens, MD, MPH, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, 600 North Wolfe Street, Phipps 279, Baltimore, MD 21287. E-mail: [email protected] Submitted June 8, 2015. Accepted for publication June 11, 2015. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2016 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2015.06.011
Owens et al.
Management of IUD Perforation
References 1. Kaislasuo J, Suhonen S, Gissler M, et al. Intrauterine contraception: incidence and factors associated with uterine perforationda populationbased study. Hum Reprod. 2012;27:2658–2663.
157 2. Kassab B, Audra P. The migrating intrauterine device. Case report and review of the literature. Contracept Fertil Sex. 1999;27:696–700. 3. Gill RS, Mok D, Hudson M, et al. Laparoscopic removal of an intraabdominal intrauterine device: case and systematic review. Contraception. 2012;85:15–18.
Laparoscopic Management of an Unusual Intrauterine Device Perforation After Postplacental Insertion Lauren Owens, MD, MPH*, Adi Rattner, AB, Anne Burke, MD, MPH, and Tola Fashokun, MD From the Department of Gynecology and Obstetrics, Johns Hopkins Hospital (Dr. Owens), Johns Hopkins University School of Medicine (Ms. Rattner and Dr. Fashokun), and Department of Gynecology and Obstetrics, Johns Hopkins Bayview (Dr. Burke), Baltimore, MD.
DISCUSS
You can discuss this article with its authors and with other AAGL members at http:// www.AAGL.org/jmig-22-6-JMIG-D-15-00351.
Use your Smartphone to scan this QR code and connect to the discussion forum for this article now* * Download a free QR Code scanner by searching for ‘‘QR scanner’’ in your smartphone’s app store or app marketplace.
A 36-year-old woman (gravida 5, para 4014) underwent term vaginal delivery and postplacental intrauterine device (IUD) placement. On postpartum day 13, she presented with abdominal pain, leukocytosis (15.86 ! 103/mm3), and peritoneal signs. An abdominal x-ray showed a perforated IUD (Fig. 1). During laparoscopy, the outer sheath of the IUD inserter was found to have perforated the uterus Fig. 1 Preoperative abdominal x-ray with retained sheath. The arrow indicates the inserter sheath with retained intrauterine device.
(Fig. 2). The IUD and inserter sheath were sequentially removed through the vagina under laparoscopic visualization. The patient’s pain improved postoperatively, and she was discharged on postoperative day 2. Although uterine perforation is a known complication of IUD insertion with an incidence of 0.4 of 1000 women, this is the first reported case of uterine perforation by a retained IUD inserter [1]. Extrauterine IUDs must be removed because of the potential of damage to nearby organs [2]. In 179 cases of IUD perforation, 64.2% of IUDs were removed laparoscopically [3]. Adhesions and bowel perforation are associated with conversion to laparotomy. Fig. 2 Intraoperative photograph of perforation. Upon anteverting the uterus, the intrauterine device (IUD) sheath perforating the fundus was found immediately. The IUD is still within the sheath in this photography.
Corresponding author: Lauren Owens, MD, MPH, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, 600 North Wolfe Street, Phipps 279, Baltimore, MD 21287. E-mail: [email protected] Submitted June 8, 2015. Accepted for publication June 11, 2015. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2016 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2015.06.011
Owens et al.
Management of IUD Perforation
References 1. Kaislasuo J, Suhonen S, Gissler M, et al. Intrauterine contraception: incidence and factors associated with uterine perforationda populationbased study. Hum Reprod. 2012;27:2658–2663.
157 2. Kassab B, Audra P. The migrating intrauterine device. Case report and review of the literature. Contracept Fertil Sex. 1999;27:696–700. 3. Gill RS, Mok D, Hudson M, et al. Laparoscopic removal of an intraabdominal intrauterine device: case and systematic review. Contraception. 2012;85:15–18.
