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Laparoscopic removal of a migrated intrauterine device

2007, Urology journal

Case Reports Laparoscopic Removal of a Migrated Intrauterine Device Farzaneh Sharifiaghdas, Faramarz Mohammadali Beigi, Hamidreza Abdi Keywords: laparoscopy, intrauterine device, migration Urol J. 2007;4:177-9. www.uj.unrc.ir ch ive of SI Using intrauterine device (IUD) is the most common method of contraception worldwide. However, there is a risk of its migration and damage to the intra-abdominal organs.(1) According to the recent reports, perforation of the uterus by IUD is seen in 0.05 to 13 cases out of 1000 IUD insertions.(2) The primary rupture of the uterus has been reported at the time of IUD insertion; however, the secondary or delayed rupture is more common and seems to be due to the spasms of the uterus.(2) removed because of her willingness for pregnancy, and thereafter, she had bleeding for 20 days. She conceived her second child and after the second labor, an IUD was inserted. Three months later, she experienced suprapubic pain during diuresis. She did not have hematuria or other urinary symptoms and her medical examination was unremarkable. Routine laboratory tests including urinalysis had normal results. The patient underwent ultrasonography and increased thickness of the anterior wall of the bladder with a soft tissue mass and the IUD in the space between the bladder and the uterus were detected. On plain abdominal radiography, the shadow of the IUD was seen in the middle of the pelvic space, and computed tomography confirmed the IUD in the space between the uterus and the bladder (Figure 1). The patient then underwent cystoscopy and a prominent mucosal dome was detected in the bladder formed due to the pressure from the outside. The IUD was not seen in the bladder and the bladder mucosa was intact. Finally, the diagnosis of IUD migration from the uterus into the space between the bladder and the uterus was confirmed and laparoscopic method was chosen to remove it. D INTRODUCTION Ar Concerning the risk of adhesion and injury to the intestine and bladder, surgical removal of the intra-abdominally migrated IUD is recommended and 2 methods of open surgery and laparoscopy have been reported for this purpose.(3) Open surgery is accompanied by complications such as cosmetic problems and longer hospitalization, and laparoscopy may be an appropriate treatment of IUD migration because of a better view, more magnification, and a smaller surgical incision. We report a case of IUD migration into the pelvis in a young woman. Department of Urology, Shaheed Labbafinejad Medical Center, Shaheed Beheshti Medical University, Tehran, Iran Corresponding Authors: Farzaneh Sharifiaghdas, MD Department of Urology, Shaheed Labbafinejad Medical Center, Pasdaran, Tehran, Iran Tel: +98 21 2256 7222 Fax: +98 21 2256 7282 E-mail: [email protected] Received January 2007 Accepted March 2007 Urology Journal Vol 4 No 3 CASE REPORT Our patient is a 35-year-old woman who has been using IUD for 5 years after her first labor. The IUD was Summer 2007 Following general anesthesia, 3 ports were made with the patient in the supine position. One was placed 10 177 www.SID.ir D Laparoscopy for Intrauterine Device Migration—Sharifiaghdas et al SI Figure 3. The intrauterine device was freed from the adjacent adhesions between the bladder and the uterus. of uterine covered by the omentum was seen. After releasing the adhesions, the IUD was removed within 15 minutes (Figure 3). The patients’ catheter was removed 2 days later, and then, she was discharged from the hospital. No complication was seen during the procedure and the patient did not have any problems during the 3-month follow-up. ch ive DISCUSSION Figure 1. Detection of the intrauterine device by imaging. Top, Plain abdominal radiography. Bottom, Intrauterine device in the space between the bladder and the uterus on computed tomography scan. Ar mm from the umbilicus for the camera and 2 were placed in 5-mm distance in the pararectal parts at the level of the umbilicus on the right and left (Figure 2). In laparoscopy, a space in the anterior part of the Figure 2. Trocar insertion sites for laparoscopy. Large midline incision was avoided by this approach. 178 Migration of the IUD into the abdominal cavity is very rare. In our review of the literature, 165 cases of IUD migration have been reported since 1999. The most common places for this migration are the omentum, rectosigmoid colon, peritoneum, and bladder. Other rare places for IUD migration include the appendix, small intestine, adenexes, iliac veins, secum, perirectal fat, retroperitoneal space, Douglas pouch, and ovaries.(4-9) Most of the authors recommend removal of the copper IUD in case of migration, because inflammatory responses can cause intestinal obstruction and visceral perforation. Laparotomy and laparoscopic management have been used for IUD removal in the cases with IUD migration. Since laparatomy is accompanied by more manipulations, more scarring, and longer hospitalization, and has a more limited view during the operation, laparoscopy has now become the method of choice for the treatment. Successful treatment of IUD migration by laparoscopy has been reported in a few cases.(3,6-8) The average period of laparoscopy has been reported to be 25 minutes and the maximum hospital stay to be 1 day, which are significantly shorter than those for open surgery. Urology Journal Vol 4 No 3 Summer 2007 www.SID.ir Laparoscopy for Intrauterine Device Migration—Sharifiaghdas et al No complication has so far been reported by this method. Injury to the intestine needing repair and sepsis have been considered as the contraindications for laparoscopy.(6,8) However, in such cases, laparoscopy is a fast, easy, and noninvasive method for the diagnosis of the place of the IUD and its removal. Gynecol Laparosc. 2003;10:539-41. 4. Kassab B, Audra P. [The migrating intrauterine device. Case report and review of the literature]. Contracept Fertil Sex. 1999;27:696-700. French. 5. Sarkar P. Translocation of a copper 7 intra-uterine contraceptive device with subsequent penetration of the caecum: case report and review. Br J Fam Plann. 2000;26:161. 6. Silva PD, Larson KM. Laparoscopic removal of a perforated intrauterine device from the perirectal fat. JSLS. 2000;4:159-62. REFERENCES Stuckey A, Dutreil P, Aspuru E, Nolan TE. Symptomatic cecal perforation by an intrauterine device with appendectomy removal. Obstet Gynecol. 2005;105:1239-41. 7. Roy KK, Banerjee N, Sinha A. Laparoscopic removal of translocated retroperitoneal IUD. Int J Gynaecol Obstet. 2000;71:241-3. 8. 2. Grimaldi L, De Giorgio F, Andreotta P, D>Alessio MC, Piscicelli C, Pascali VL. Medicolegal aspects of an unusual uterine perforation with multiload-Cu 375R. Am J Forensic Med Pathol. 2005;26:365-6. Demir SC, Cetin MT, Ucunsak IF, Atay Y, Toksoz L, Kadayifci O. Removal of intra-abdominal intrauterine device by laparoscopy. Eur J Contracept Reprod Health Care. 2002;7:20-3. 9. 3. Gungor M, Sonmezer M, Atabekoglu C, Ortac F. Laparoscopic management of a translocated intrauterine device perforating the bowel. J Am Assoc Ozdemir H, Mahmutyazicioglu K, Tanriverdi HA, Gundogdu S, Savranlar A, Ozer T. Migration of an intrauterine contraceptive device to the ovary. J Clin Ultrasound. 2004;32:91-4. Ar ch ive of SI D 1. Urology Journal Vol 4 No 3 Summer 2007 179 www.SID.ir