Perforated intraperitoneal intrauterine contraceptive devices: diagnosis, management, and clinical outcomes.
OBJECTIVE
To describe a series of intraperitoneal perforated intrauterine contraception devices (IUDs) and to discuss associated findings, methods for diagnosis, and management of this complication.


METHODS
Retrospective review of surgical database between 1998 and 2012 (Canadian Task Force classification II-2).


METHODS
University medical center.


METHODS
Thirty-seven women with a perforated IUD in the intraperitoneal cavity.


RESULTS
Nineteen copper IUDs (51%), 17 levonorgestrel-releasing IUDs (LNG-IUDs) (46%), and 1 Lippes loop (3%) were identified. Twenty women (54%) had abdominal pain, 16 (43%) had no symptoms, and 1 (3%) was found to have strings protruding from her anus. Twenty-six women (70%) underwent laparoscopy to remove the IUD, and 6 (16%) underwent hysteroscopy along with laparoscopy. Conversion to laparotomy was required in 4 patients (11%). Two IUDs (5%) caused full-thickness rectouterine fistulas that required laparotomy for repair. Dense adhesions were found in 21 women (57%); and of those, 15 (71%) were associated with a copper IUD. Copper IUDs were significantly more likely than LNG-IUDs to be associated with dense adhesions (p = .02).


CONCLUSIONS
Perforated IUDs can be asymptomatic or cause short-term and long-term symptoms. Long-term complications include abscess and fistula formation. Copper IUDs cause a greater inflammatory process than do LNG-IUDs. Even if asymptomatic, we advocate prompt removal of all IUDs that perforate into the peritoneal cavity once they are identified. Laparoscopic surgical removal of an intraperitoneal IUD is a safe and preferred method.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: Kimberly.Kho@utsouthwestern.edu.
Kimberly A
KA
Kho
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
Dina J
DJ
Chamsy
D000328:Adult; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D058736:Intrauterine Device Migration / Q000009:adverse effects*; D007434:Intrauterine Devices / Q000009:adverse effects; D007435:Intrauterine Devices, Copper / Q000009:adverse effects*; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects; D010535:Laparoscopy; D012003:Rectal Fistula / Q000209:etiology; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology; D014591:Uterine Diseases / Q000209:etiology; D014595:Uterine Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D055815:Young Adult
Intra-abdominal; Intraperitoneal; Laparoscopy; Missing IUD; Perforated