Levonorgestrel intrauterine system embedded within tubal ectopic pregnancy: a case report

Makena, Dorothy; Gichere, Ingrid; Warfa, Khadija

doi:10.1186/s13256-021-02723-7

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…No entanto, após um ano da inserção, ao buscar o serviço médico para removê-lo, o dispositivo não estava no lugar e não foi localizado nem pela ginecologista e nem pelo ultrassom. Com a cirurgia, constatou a GE rota e o DIU embutido no final das fímbrias da tuba uterina esquerda (MAKENA et al, 2021).…”

Section: Resultsunclassified

Uso prolongado de DIU como fator de risco para Gravidez Ectópica / Prolonged IUD use as a risk factor for Ectopic Pregnancy

Campos¹,

Diamante²,

Ribeiro³

et al. 2021

BJDV

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RESUMOINTRODUÇÃO: A gravidez ectópica (GE) é responsável por elevada morbimortalidade, sendo um tema relevante entre as síndromes hemorrágicas na gravidez. A sua etiologia envolve fatores de riscos como: história prévia de GE, infecções pélvicas, infertilidade, tabagismo e uso de dispositivo intrauterino. Acredita-se que esses fatores causam alterações funcionais e estruturais da tuba uterina. Contudo, a associação do uso prolongado de DIU como fator de risco para gravidez ectópica não apresenta explicações biológicas definitivas. É sugestivo que há uma relação entre maior incidência de GE com o uso de DIU. METODOLOGIA: Estudo na modalidade revisão narrativa, realizado nas bases de dados:

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Section: Resultsunclassified

Uso prolongado de DIU como fator de risco para Gravidez Ectópica / Prolonged IUD use as a risk factor for Ectopic Pregnancy

Campos¹,

Diamante²,

Ribeiro³

et al. 2021

BJDV

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“…MRI is rarely used for such evaluations, although this imaging modality can be performed safely[ 5 ]. As a result of searching for LNG-IUS, perforation, and migration, there were 6 similar case reports, including this case (Table 1 )[ 8 - 12 ]. At the time of diagnosis, 3 patients were asymptomatic, and 3 patients had lower abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

Importance of abdominal X-ray to confirm the position of levonorgestrel-releasing intrauterine system: A case report

Maebayashi¹,

Kato²,

Hayashi³

et al. 2022

WJCC

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BACKGROUND Levonorgestrel-releasing intrauterine systems (LNG-IUSs) gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea. Complications associated with the insertion include expulsion, displacement, and uterine perforation. Ultrasonic identification of copper intrauterine devices (IUDs) is possible due to echogenicity from the copper coils. However, the barium sulfate coatings of LNG-IUSs do not always provide hyperechoic images. Both barium sulfate and copper are radiopaque and clearly identifiable on X-ray. Thus, X-ray imaging is required to locate LNG-IUSs. CASE SUMMARY A 46-year-old woman with hypermenorrhoea due to submucosal myomas was treated with LNG-IUS at another hospital. Three LNG-IUS insertions had apparently been followed by spontaneous expulsion, although objective confirmation using imaging was not performed. The patient was referred to our institution for surgery. At the first visit, there appeared to be no device in the uterus, and none was observed on transvaginal ultrasound. However, two LNG-IUSs were observed in the pelvis on abdominal plain X-rays prior to surgery. Hysteroscopic myomectomy was performed, and the two LNG-IUSs were found to have perforated the myometrium. The devices were safely removed during surgery, and the submucosal myomas were also removed. The perforated section of the myometrium was minimal+ADs- therefore, a repair operation was not required. CONCLUSION Plain abdominal X-rays facilitate the determination of whether an LNG-IUS is in the uterine cavity. Therefore, it is important to confirm a device’s location, regardless of whether spontaneous expulsion is suspected, prior to inserting another device.

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“…The higher risk of perforation occurs during the IUD insertion, and only 8.5% are immediately detected 4 . On the other side, there has been reported late migration of the IUD to the abdominal cavity after over four weeks of insertion, which can result in severe complications such as abdominal adherences or bowel perforation 3,5 . As this type of complication is rare, the pathophysiology of late migration is still known 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Ovary transmigration of a levonorgestrel-releasing intrauterine device and ectopic pregnancy: a case report

Lafraia,

Barbosa,

Zorzanelli

et al. 2023

Hum. Reprod. Arch.

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Introduction: Intrauterine devices (IUD) are safe long-term contraceptive methods frequently used. Though it is a rare event, the uterine perforation and migration of an IUD is possible. Case description: This study is based on a single patient who has been using Levonorgestrel (LNG)-IUD for the last two years without previous complications. A control ultrasound in October/2019 reported a normally placed LNG-IUD. However, in July/2020, she was admitted to our hospital with intermittent pain in the right iliac fossa associated with minor vaginal bleeding for the last 30 days. Her hCG level was 827,3 mUI/mL. The LNG-IUD was not identified in the ultrasound exam, and there was a mass of 5.6 centimeters with a hyperechogenic line in the right adnexa. In surgery, we found a right tubal ectopic pregnancy, and the LNG-IUD was located within the right ovary parenchyma, confirmed by pathological examination. We performed a right salpingo-oophorectomy, and there were no procedure complications. The patient presented good clinical evolution, receiving discharge the next day. Discussion: The spontaneous IUD migration can affect any adjacent structures, but the exact pathophysiology is unknown. Although uterine perforation and migration are rare complications, the medical team should discuss their possibility with the patient before IUD insertion. Moreover, professionals should be aware of this possibility and diagnose it rapidly to avoid further complications. With this case report we intend to review similar cases described previously and discuss the best options available for management of this complex situation.

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Levonorgestrel intrauterine system embedded within tubal ectopic pregnancy: a case report

Cited by 5 publications

References 23 publications

Uso prolongado de DIU como fator de risco para Gravidez Ectópica / Prolonged IUD use as a risk factor for Ectopic Pregnancy

Uso prolongado de DIU como fator de risco para Gravidez Ectópica / Prolonged IUD use as a risk factor for Ectopic Pregnancy

Importance of abdominal X-ray to confirm the position of levonorgestrel-releasing intrauterine system: A case report

Ovary transmigration of a levonorgestrel-releasing intrauterine device and ectopic pregnancy: a case report

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