RESUMO
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.
Assuntos
Expulsão de Dispositivo Intrauterino , Migração de Dispositivo Intrauterino/efeitos adversos , Dispositivos Intrauterinos de Cobre/efeitos adversos , Dispositivos Intrauterinos Medicados/efeitos adversos , Perfuração Uterina/cirurgia , Adolescente , Adulto , Brasil/epidemiologia , Árvores de Decisões , Remoção de Dispositivo , Feminino , Seguimentos , Humanos , Histerossalpingografia , Laparoscopia , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Pelve/cirurgia , Estudos Retrospectivos , Ultrassonografia , Perfuração Uterina/diagnóstico por imagem , Perfuração Uterina/epidemiologia , Útero/diagnóstico por imagem , Útero/cirurgia , Adulto JovemRESUMO
The application of a copper IUD can perforate completely the uterus and involve adjacent organs such as the bladder, small bowel, colon, rectum or appendix. Once the diagnosis is established, complete extraction must follow. We present a case report of a 33 year-old patient in which a copper IUD was placed in a medical office, three months after a third cesarean, without history of sepsis. Ninety days after placement, the patient complained of menstrual irregularities (opsomenhorrea) without any other symptoms. On physical examination with speculum, the IUD's guide strings were not visible; a transvaginal USG was performed without visualization of the IUD in the uterine cavity. An abdominal CAT scan showed the presence of the IUD outside the uterus. Hysteroscopy-laparoscopy was performed with transoperatory fluoroscopy, which revealed the copper IUD inside the yeyunum, a complete extraction followed with entero-entero anastomosis. This case will show that IUD placement is not innocuous and that adjacent organ damage must always be considered and resolved immediately.
Assuntos
Perfuração Intestinal/etiologia , Dispositivos Intrauterinos de Cobre/efeitos adversos , Doenças do Jejuno/etiologia , Perfuração Uterina/etiologia , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Migração de Corpo Estranho , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/cirurgia , Jejuno/diagnóstico por imagem , Jejuno/lesões , Jejuno/cirurgia , Laparoscopia , Radiografia , Resultado do Tratamento , Perfuração Uterina/diagnóstico , Perfuração Uterina/cirurgia , Útero/lesões , Útero/cirurgiaRESUMO
We performed a retrospective observational review-based study of the medical records of consecutive women with diagnosis of spontaneous uterine perforation, between 1995 and 2003. During this period 3 patients with an average age of 76.2 years and with acute abdominal pain attended to the emergency department. Physical examination revealed signs of peritoneal irritation, as a result emergency laparotomy was performed, where uterine perforation was not found in the preoperative diagnosis. All patients had purulent fluid in the abdominal cavity and uterine perforation. A total abdominal hysterectomy with bilateral salpingooophorectomy was carried out under the diagnosis of generalized peritonitis caused by spontaneous perforation of pyometra. They also required cavity lavage, drainages placement, and antibiotics. Histological examination revealed uterine perforation and pyometra without evidence of malignancy. Prognosis was good and they were discharged on postoperative day 8.5 without complications. Spontaneous uterine perforation, secondary to pyometra, should be considered in the differential diagnosis of acute abdomen in postmenopausal patients, still without gynecological signs.
Assuntos
Doenças Uterinas/complicações , Perfuração Uterina/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Retrospectivos , Supuração/complicações , Supuração/cirurgia , Doenças Uterinas/cirurgia , Perfuração Uterina/cirurgiaRESUMO
Se presenta la experiencia de 18 pacientes sometidas a cirugía laparoscópica por DIU intraabdominal, en las cuales el diagnóstico se realizó por ecotomografía transvaginal y radiografía de pelvis. En todos los casos su extracción se realizó sin complicaciones ni conversión a laparotomía. Se discute el cuadro clínico, diagnóstico, tratamiento y eventuales complicaciones.
Assuntos
Adolescente , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Dispositivos Intrauterinos/efeitos adversos , Laparoscopia , Migração de Corpo Estranho/cirurgia , Perfuração Uterina/cirurgia , Pelve , Perfuração Uterina/diagnóstico , Perfuração Uterina/etiologia , Remoção de Dispositivo/métodos , VaginaRESUMO
Uterine perforation secondary to placement of intrauterine devices is a rare complication that may affect contiguous organs such as bladder, small intestine, rectum, and sigmoid; all extremely serious depending on the organ involved. We report the case of a 22-year-old woman with complete uterines perforation due to intrauterine device affected that rectum sigmoid with asymptomatic presentation. We emphasize the postoperatory evolution and its management as well as a literature review.
Assuntos
Dispositivos Intrauterinos/efeitos adversos , Perfuração Uterina/diagnóstico , Adulto , Colo Sigmoide/lesões , Colo Sigmoide/cirurgia , Colostomia , Feminino , Humanos , Reto/lesões , Reto/cirurgia , Literatura de Revisão como Assunto , Perfuração Uterina/etiologia , Perfuração Uterina/cirurgia , Útero/lesões , Útero/cirurgiaRESUMO
A case is reported of the presence of an intrauterine device into the bladder due to uterine perforation with calculus formation in a 39 year old woman, with two pregnancies after its installation. The patient was seen for complaints of pelvic pain, pollakiuria, dysuria and tenesmus, without uterine sintomatology. The case was studied in July of 1993 in the General Hospital "Vicente Guerrero" of Acapulco. To our knowledge only 19 previous cases have been reported in the literature of migration of an intrauterine device into the bladder with calculus formation. The literature is reviewed and we discuss the clinico-radiological findings.
Assuntos
Migração de Corpo Estranho , Dispositivos Intrauterinos/efeitos adversos , Cálculos da Bexiga Urinária/etiologia , Perfuração Uterina/etiologia , Adulto , Cistoscopia , Feminino , Humanos , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Cálculos da Bexiga Urinária/diagnóstico por imagem , Cálculos da Bexiga Urinária/cirurgia , Urografia , Perfuração Uterina/diagnóstico por imagem , Perfuração Uterina/cirurgiaRESUMO
PIP: The article reports on the case of a 21-year old patient whose Lippes Loop D had translocated into the abdominal cavity causing uterine perforation and amenorrhea. The device was easily removed by culdoscopy, and amenorrhea, caused by the partial distruction of the endometrium, treated with hormonal therapy.^ieng