Dislocated intrauterine devices: clinical presentations, diagnosis and management

Tabatabaei, Fatemeh; Masoumzadeh, Mahdiyeh

doi:10.1080/13625187.2021.1874337

Cited by 11 publications

(10 citation statements)

References 23 publications

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“…Perforation management depends on the stability of the patient. Type of surgery either with laparoscopy or laparotomy should be planned (44). Expectant management of displaced IUDs in asymptomatic patients is not recommended due to risks of bowel or bladder perforation, intestinal obstruction and chronic pelvic pain as well as complicated pelvic abscesses (46).…”

Section: Failure Expulsion and Perforationmentioning

confidence: 99%

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Intrauterin Devices: What Has Changed?

Uysal¹

2022

JEURMEDS

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Intra-uterine devices (IUDs) are one of the most common, long acting, reversibly-used methods of contraception in the world. IUDs are safe and effective T shaped designed plastic framed devices including copper or levonorgestrel. The purpose of this review was to outline the types, mechanisms, benefits, and adverse effects of IUDs and to help for selection of candidates and devices. The most important role in the mechanism of action is to cause sterile inflammation in the uterine cavity. Hormonal IUDs have also non-contraceptive benefits like reduction in heavy menstrual bleeding, dysmenorrhea, pelvic pain, endometrial hyperplasia and anemia. Pelvic inflammatory disease (PID), ectopic pregnancy, anemia and progestin related complaints including acne, weight change, headache, mood changes, hirsutism and nausea are some undesirable effects of IUDs. IUDs are highly preferred in the world and will not be abandoned in the future. They are easily accessible, cheap and cost-effective for contraception.

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Section: Failure Expulsion and Perforationmentioning

confidence: 99%

“…Initial evaluation including kidneys, ureter, bladder and intestines should be performed. Vaginal delivery is not a contraindication after IUD perforation (44).…”

Section: Failure Expulsion and Perforationmentioning

confidence: 99%

Intrauterin Devices: What Has Changed?

Uysal¹

2022

JEURMEDS

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“…Although the IUD can migrate to any organ, many cases reported in recent years have found migration to the intestinal tract (4)(5)(6), urinary tract (7), omentum (8), and intrathoracic cavity (9). Uterine perforation and IUD migration are critical complications of IUD insertion and can be successfully treated by laparoscopy, or by laparotomy in cases of severe pelvic adhesion or unforeseen complications (10,11). In addition to gynecological examination, abdominal ultrasound, transvaginal ultrasound, 3D ultrasound, and CT have been used to diagnose and locate migrated IUDs (12).…”

Section: Introductionmentioning

confidence: 99%

Case report: An intrauterine device hugging the musculus rectus abdominis through the center of a cesarean scar

Jing

2023

Front. Surg.

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A 34-year-old woman presented with an abscess of the abdominal wall, with a 10-day history of rupture and discharge. She had a history of cesarean section 17 years ago, intrauterine device (IUD) insertion 5 years ago, and intermittent lumbago and abdominal pain for the past 4 years. A V-shaped IUD was observed via ultrasound between the bladder and abdominal wall, clinging to the musculus rectus abdominis through the center of the cesarean scar. Pelvic computed tomography (CT) revealed a V-shaped metal density at the anterior upper edge of the bladder, one end of which seemed to penetrate the abdominal wall. IUD migration was confirmed by surgery 2 days later. The patient recovered after IUD removal. This case affirms that a migrated IUD can lead to serious complications, even if there are no obvious symptoms for many years. Apart from the fact that the IUD has fallen out of place, a migrated IUD should be removed promptly, regardless of obvious complications. Furthermore, regular ultrasound examination is important for early diagnosis of IUD displacement. Based on the relevant literature, we also hypothesize the possible mechanism of IUD migration between the anterior bladder wall and the abdominal wall.Core tipUterine perforation and IUD migration to the organs in the abdominopelvic cavity are serious complications of IUD insertion. We present a case of uterine perforation complicated by IUD migration with the application of intraoperative ultrasound localization. This case highlights that ultrasound, especially intraoperative ultrasound, can provide objective information for the diagnosis and localization of IUD migration, with the advantages of point of care, real-time imaging, convenience, low cost, and lack of radiation. Based on this case and on the relevant literature, we hypothesized the possible mechanism of IUD migration between the anterior bladder wall and the abdominal wall. To the best of our knowledge, no previous research has discussed the process of IUD migration beyond the anterior wall of the bladder.

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“…To our knowledge, complications occur rarely, of 1/1000 insertions [ 1 ], but these can be severe and life-threatening, such as intramural IUD migration, with one of two manifestations: embedment, in which case it does not exceed the serosa, remaining at the level of myometrium, or perforation, in which case it can migrate to the organs inside the peritoneal cavity, a situation encountered in 85% of cases [ 1 ]. Another complication described was related to an intrauterine device identified within an ovarian tumor, in a 63-year-old patient, without a clear explanation as to whether the tumor was a consequence of the migration of the IUD inside the ovary or its development was concomitant [ 1 ]. The mechanism of migration remains unknown [ 1 ], but uterine contractions are thought to play a role [ 2 , 3 , 4 ].…”

mentioning

confidence: 99%

“…Another complication described was related to an intrauterine device identified within an ovarian tumor, in a 63-year-old patient, without a clear explanation as to whether the tumor was a consequence of the migration of the IUD inside the ovary or its development was concomitant [ 1 ]. The mechanism of migration remains unknown [ 1 ], but uterine contractions are thought to play a role [ 2 , 3 , 4 ]. According to Chai et al, two devices encountered in the same patient were described as migrating devices, the second one being inserted during a cesarean section procedure, both exceeding the uterine serosa and discovered on CT scan, the second one being inserted after considering the first one, erroneously, “lost” [ 5 ]; this incident draws attention to the importance of an accurate diagnosis before making a decision to mount another intrauterine device.…”

mentioning

confidence: 99%

An Interesting Image of Transmural Migration of a Levonorgestrel-Releasing Intrauterine Device (LNg-IUD)

et al. 2022

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Intrauterine devices (IUDs) are very common as a method of birth control. By adding progesterone (levonorgestrel), a decrease in the risk of complications has been documented, including the risk of perforation. Even though only a few complications have been described, adjacent organs may be involved in the case of migration—a life-threatening situation. A 45-year-old G4P2 woman was seen in our clinic for LNg-IUD removal, according to the medical instructions. Her main complaints were abdominal discomfort, low back pain, and recurrent menorrhagia. A “lost” IUD was initially suspected; the patient confirmed the detection and removal of the control strings, and a subsequent discussion related to delayed transmural migration of the IUD being followed. The ultrasonography revealed the migration of the IUD to the uterine cervix and size-decreased uterine fibroids, confirming the effectiveness of the LNg-IUD. The MRI and ultrasonography being useless, a subsequent X-ray and CT scan were requested, both confirming a myometrium-positioned IUD, adjacent to the serosa and lumbosacral plexus. Even though the IUD is considered a safe device with reversible effect, it can be associated with severe morbidity, with an ultrasound follow-up being required. For more precise detection of the IUD, we strongly recommend an X-ray or CT scan examination, followed by safe removal.

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Dislocated intrauterine devices: clinical presentations, diagnosis and management

Cited by 11 publications

References 23 publications

Intrauterin Devices: What Has Changed?

Intrauterin Devices: What Has Changed?

Case report: An intrauterine device hugging the musculus rectus abdominis through the center of a cesarean scar

An Interesting Image of Transmural Migration of a Levonorgestrel-Releasing Intrauterine Device (LNg-IUD)

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