RESUMO
RESUMEN El dispositivo intrauterino (DIU) es un método anticonceptivo muy popular, eficaz y seguro. Aunque posee complicaciones bien descritas como es la migración, la que puede ser a otros órganos dentro de la cavidad peritoneal. La fístula uteroyeyunal es un evento clínico poco frecuente, pero de gran repercusión si no es diagnosticada y tratada. Se presenta el caso de una paciente usuaria de DIU, el que migra a cavidad abdominal, con posterior formación de fístula uteroyeyunal.
ABSTRACT The intrauterine device is a popular, efficient and safe contraceptive. Although it has some well described complications, such as migration, which may be to the different organs inside of the peritoneal cavity. The uterus-jejunal fistula is a rare clinical event, but with great repercussion if it is not well assessed and treated properly. We present the clinical case of a patient with a migrated intrauterine device and a fistula uterus-jejunal formation.
Assuntos
Humanos , Feminino , Adulto , Doenças Uterinas/etiologia , Migração de Dispositivo Intrauterino/efeitos adversos , Fístula/etiologia , Doenças do Jejuno/etiologia , Doenças Uterinas/cirurgia , Laparoscopia , Fístula/cirurgia , Perfuração Intestinal , Doenças do Jejuno/cirurgiaAssuntos
Humanos , Feminino , Adulto , Reto/lesões , Migração de Corpo Estranho/cirurgia , Remoção de Dispositivo/métodos , Migração de Dispositivo Intrauterino/efeitos adversos , Dispositivos Intrauterinos , Tomografia Computadorizada por Raios X , Migração de Corpo Estranho/diagnóstico por imagem , ColonoscopiaRESUMO
Se presenta el caso clínico de un dispositivo intrauterino parcialmente migrado a cavidad pélvica e incrustado en serosa de rectosigmoides luego de 8 años de su inserción. El diagnóstico se realizó mediante ecografía transvaginal y retiro del dispositivo por laparoscopia. Se realizó rafia de serosa rectal y de útero. La paciente tuvo un postoperatorio sin complicaciones.
It is shown the clinical case of an intrauterine device partially migrated to the pelvic cavity and embedded in the serous rectosigmoid eight years after insertion. The diagnosis was made by transvaginal ultrasound and laparoscopy removal of the device by laparoscopy. Suture of rectum serous and uterus were performed. The patient had an uneventful postoperative course.
Assuntos
Humanos , Feminino , Adulto , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Dispositivo Intrauterino/efeitos adversos , Reto/cirurgia , Reto/lesões , Membrana Serosa , Colo Sigmoide/cirurgia , Colo Sigmoide/lesões , Migração de Corpo Estranho/cirurgia , Ultrassonografia , Laparoscopia , Remoção de DispositivoRESUMO
Dispositivo intrauterino pode sofrer expulsão da cavidade uterina. Objetivo: Descrever um caso de tratamento videolaparoscópico para retirada de dispositivo intrauterino de fossa ilíaca direita. Material e Métodos: Jovem do sexo feminino apresentou dor em fossa ilíaca direita de quatro dias de duração. No exame físico, apresentava dor abdominal localizada em fossa ilíaca direita, com discreta resistência de parede e dor à percussão e descompressão brusca na região. Em tomografia computadorizada, evidenciou-se dispositivo intrauterino fora do útero, na fossa ilíaca direita. Foram utilizadas as bases de dados SciELO, MedLine, Sobracil e PubMed no período compreendido de Abril a Junho de 2014. Vinte e dois artigos foram relacionados, entretanto somente os 10 artigos que compõem as referências bibliográficas foram selecionados por conter informações relevantes acerca do tema. Resultados: Na videolaparoscopia, pôde ser observado DIU em fossa ilíaca direita, próximo ao intestino, fora do útero, sem aderência, sem perfurações evidentes ou maiores complicações. Conclusão: A videolaparoscopia permite a retirada adequada de dispositivo intrauterino localizado indevidamente fora da cavidade uterina; permite inclusive avaliação adequada de toda a região pélvica para excluir lesões associadas.(AU)
Intrauterine device may suffer expulsion of the uterine cavity. Objective: To describe a laparoscopic treatment of the case for removal of intrauterine device right iliac fossa. Material and Methods: Young female presented pain in the right iliac fossa of four days. On physical examination, showed abdominal pain localized in the right iliac fossa, with thin wall of resistance and pain on percussion and rebound in the region. In CT scan it was seen an intrauterine device outside the uterus, in the right iliac fossa. The SciELO, MedLine, Sobracil and PubMed databases were used in the period April to June 2014. Twenty-two articles were related, though only 10 articles that make up the references were selected because they contain important information about the theme. Results: In the laparoscopy it could be observed the IUD in the right iliac fossa, near the intestine, outside the uterus, without grip, with no obvious or larger perforations complications.Conclusion: Laparoscopy allows adequate removal of intrauterine device located improperly outside the uterine cavity; even allows proper evaluation of the entire pelvic region to rule out associated injuries.(AU)
Assuntos
Feminino , Laparoscopia/métodos , Cirurgia Vídeoassistida/métodos , Remoção de Dispositivo/métodos , Migração de Dispositivo Intrauterino/efeitos adversos , Migração de Dispositivo Intrauterino/etiologia , Abdome/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
La migración de un dispositivo intrauterino a la cavidad abdominal es una complicación poco frecuente de este eficaz método contraceptivo, sin embargo debe sospecharse ante la imposibilidad de visualizar los hilos del dispositivo vía vaginal y la ausencia intrauterina del mismo por ecografía. Si bien la migración abdominal puede ser asintomática, algunos casos pueden producir clínica de severidad variable incluyendo dolor abdominal y complicaciones derivadas de la formación de adherencias o la perforación de vísceras pélvicas y abdominales. Su detección intraabdominal debe sospecharse en primer lugar por ecografía y confirmarse mediante radiología simple de abdomen. Una vez localizado el dispositivo migrado, se recomienda su extracción inmediata, incluso en casos asintomáticos, con el fin de evitar las complicaciones derivadas de su desplazamiento. La laparoscopia será de primera elección en estos casos para la extracción. Presentamos un caso de migración intraabdominal de dispositivo intrauterino concurrente a un embarazo intrauterino no evolutivo.
Migration of an intrauterine device to the abdominal cavity is a rare complication of this effective contraceptive method, however, it must be suspected upon the inability to visualize the wires vaginally and the absence of intrauterine device by ultrasound. While its abdominal migration can be asymptomatic, some cases may produce variable clinical severity including abdominal pain and complications resulting from the formation of adhesions or perforation of pelvic and abdominal viscera. Its intraabdominal detection should be suspected first by ultrasound and confirmed by plain abdominal X-ray. Once the migrated device is located, immediate removal is recommended, even in asymptomatic cases, in order to avoid complications arising from its displacement. Laparoscopy will be the first choice in these cases for extraction. We report a case of intraabdominal migration of intrauterine device concurrent with a non-evolutive intrauterine pregnancy.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Migração de Corpo Estranho/cirurgia , Cavidade Abdominal , Migração de Dispositivo Intrauterino/efeitos adversos , Perfuração Uterina/cirurgia , Perfuração Uterina/etiologia , Migração de Corpo Estranho/diagnóstico por imagem , Laparoscopia , Remoção de DispositivoRESUMO
BACKGROUND: A common question among health care professionals is how to manage nonvisible strings in users of intrauterine contraceptives (IUCs) at repeat follow-up visits. This study assessed the position of the IUCs in women who consulted repeatedly with nonvisible IUC strings. STUDY DESIGN: The medical records of the clinic were reviewed to identify new acceptors and switchers who had an IUC inserted between 1990 and 2009. All women were identified whose IUC string could not be visualized at the external os of the cervix by the health care professional at any given follow-up visit, even after attempting a standard maneuver of sweeping the strings from the cervical canal using a cervical brush or trying to visualize the strings in the cervical canal using colposcopy. Data were also retrieved on the use of ultrasonography and/or pelvic X-ray to assess IUC position, as well as data from any subsequent visits at which the IUC strings were nonvisible. RESULTS: The medical charts of 14,935 patients using an IUC were reviewed, and 750 women (5.0%) presenting for the first time with missing IUC strings at any follow-up visit were identified. Ultrasound scans showed the IUC to be in situ in 735 cases (98.0%), while 9 women (1.2%) had expelled the device and, in 5 cases (0.7%), the device was found in the pelvis following uterine perforation. IUC strings were missing on a second occasion in 297 cases. The device was found to be in situ in 295 cases (99.3%) and had been expelled in 2 (0.7%). At subsequent consultations, (between 1 and 18 years after the first consultation), strings were missing in 113, 55, 19 and 5 cases. In 111 (98.2%), 54 (98.2%), 18 (94.7%) and 5 (100%) of these cases, respectively, the IUC was found to be in situ, while in the remaining cases, the device had been expelled. CONCLUSIONS: Missing IUC strings are an uncommon finding, and ultrasonography confirmed that the device was in situ in the majority of these cases. For women with persistent missing IUC strings after one ultrasound scan that has verified appropriate intrauterine position, given the 2.4% likelihood that expulsion may have occurred at the time of subsequent visits, repeating the ultrasound (if available) should be considered for at least one (and possibly two) additional women's visit.