Introduction The IUD is one of the most widely used reversible, long-term contraceptive methods in the world. About 80% of IUDs are found in the peritoneal cavity after uterine perforation. Case report A 27-year-old female patient presented with chronic pelvic pain with minimal metrorrhagia for 8 months on IUD. On examination, there was no IUD thread. Pelvic ultrasound showed a hypoechoic, heterogeneous, poorly limited formation measuring 3 × 2.68 cm. Abdominal-pelvic CT scan showed hyperdense supravesical material surrounded by a hypo-dense, well-limited collection measuring 26 × 25 mm. Laparoscopy showed an anterior peritoneal collection above the bladder containing the IUD, a uterus, adnexa, and a bladder without abnormality. The IUD was removed after incision of the collection and aspiration of the pus. Discussion The IUD is one of the most widely used long-term reversible contraceptive methods in the world. But like any foreign body, it can present complications, notably migration after uterine perforation, which remains rare, and even rarer peritoneal localization. The clinical diagnosis is not always obvious, and additional examinations are necessary to locate the device, including endovaginal ultrasound, a CT scan or magnetic resonance imaging. WHO recommends surgical removal of the migrated IUD by minimally invasive methods, including hysteroscopy, cystoscopy, colonoscopy, or laparoscopy, depending on the location of the IUD. Conclusion IUDs are effective contraceptive measures, and the majority of patients with uterine perforation by IUD migration are asymptomatic. Diagnosis is based on a thorough gynecologic analysis and appropriate radiologic imaging.
Introduction and importance Heterotopic pregnancy is the occurrence of pregnancies in at least two different implantation sites in the same time. The diagnosis of heterotopic pregnancy remains one of the greatest challenges of the gynecological-obstetrical emergencies. Case presentation We report a rare case of spontaneous heterotopic pregnancy of a 32-year-old woman, diagnosed with a heterotopic pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. Clinical discussion The existence of intrauterine pregnancy does not exclude an ectopic pregnancy. The occurrence of a spontaneous heterotopic pregnancy without risk factors is a rare event, the clinical symptomatology is often related to a threatened or ongoing abortion, the diagnosis of heterotopic pregnancy is not made until the appearance of signs of hemoperitoneum secondary to a ruptured EP, hence the importance of a systematic ultrasound examination of the adnexa during first trimester ultrasound. The standard treatment is conservative surgery, preferably by laparoscopy. Laparotomy retains its indications especially in forms with hemorrhagic shock. With the aim of preserving intrauterine pregnancy while removing ectopic pregnancy. Conclusion The diagnosis of heterotopic pregnancy should not be excluded by the discovery of a UGI in a spontaneous cycle. Diagnosis is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.
Introduction Spontaneous bladder rupture SBR is a rare condition and often missed diagnosis, especially after a nontraumatic vaginal delivery. Case presentation A 34-year-old patient who had a nontraumatic vaginal delivery presented to the emergency room 7 days later with acute abdomen and anuria. Computed tomography showed free fluid in the peritoneal cavity. An intraperitoneal rupture of the bladder dome was detected, showing extravasation of contrast into the peritoneal cavity. An exploratory laparotomy revealed a perforation on the bladder dome that was sutured. Clinical discussion SBR following vaginal delivery is an extremely rare condition. It represents a surgical emergency. Due to the low incidence and the presence of non-specific symptoms, diagnosis was usually delayed with an increased morbidity and mortality. Clinicians should consider this diagnosis in the presence of an acute abdominal pain associated to anuria or dysuria. We therefore recommend that the bladder be catheterized or drained before labour. Conclusion SBR is a rare and life-threatening condition in post-partum. Abdominal pain with elevated serum creatinine should be suspicious of urinary bladder rupture.
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