Misplaced Intrauterine Device (IUD): The Endoscopic Management

Abstract

were multipara. As far as timing of insertion is concerned, 6 (20%) were postpartum, 8 (26.6%) were postabortal and 16 (53.3%) were postmenstrual. Twenty three (76.6%) IUD's were inserted at primary health center, 7 (23.4%) were inserted at civil hospital and none were inserted at tertiary center. Time interval between insertion and removal is depicted in Table 1. Of the 21 misplaced intrauterine devices 10 were found partially embedded in uterine wall and 6 of the misplaced 1UD's were found deeply embedded in the uterine cavity. In four patients the device was fragmented after history of partial removal outside (Table 2). After their location they were removed hysteroscopically. One patient reported with 8 weeks pregnancy and misplaced IUD. The device was confirmed to be intrauterine on transvaginal sonography. She decided to continue the pregnancy and had uneventful antenatal course. She had full term normal delivery and IUD was removed after 6 weeks hysteroscopically. Nine patients had extrauterine migration of the IUD as diagnosed by USG and abdominopelvic X-ray. Out of 9, successful laparoscopic removal was possible in 7 (77.7%) patients and 2 patients required laparotomy for the removal although their localization was done with laparoscopy.

Endoscopic Management of Migrated Intra Uterine Device in Sub-Saharan Health Setting Area. Our Experience about Seventeen Cases

“…We agree with most of the authors [6] [16] that think that laparoscopy is invaluable in management of misplaced IUD. This method is associated with comfort, minimal hospital stay and early recovery and hence it is recommended as the preferred method for removal of misplaced IUD's [6].…”

“…This method is associated with comfort, minimal hospital stay and early recovery and hence it is recommended as the preferred method for removal of misplaced IUD's [6]. After endoscopic surgery, no death occurred in our study and mean duration of the stay of hospitalization was 2 days confirming necessity to extend this management approach in all the four teaching hospitals of Bamako.…”

“…However the management of misplaced IUD still remains controversial and no consensus opinion exists. Some in the literature suggests that the translocated IUD's should be removed electively as complications like adhesions and bowel obstruction has been reported and removal should be done as soon as the diagnosis is made [6]. In our experience, we undertook management as soon as the diagnosis of the complication done.…”

“…Its insertion is usually a simple and safe [5] process in the gynecology practice. However, this method has some side effects like menstrual bleeding, pelvis pain, infection and uterine perforation [6] that is a rare but serious complication of modern contraceptive using [4]. After uterus perforation IUD migrates into several surrounding organs especially bladder, sigmoid colon.…”

Misplaced IUCD: a case report

“…Dangerous complications associated with the misplaced IUCD include bowel perforation, rectovaginal fistula, rectal strictures, bladder perforation, bowel obstruction, appendiceal perforation and mesenteric perforation. 9 Removal of misplaced IUCD is desirable even if the patient is asymptomatic so that the future complications like perforation of the adjacent organs or any fistula development can be avoided. 4 WHO also advocates the removal of the misplaced or malpositioned IUCD because of the risk of injury to the adjoining organs and medicolegal issues.…”