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Ginecología y obstetricia de México
versão impressa ISSN 0300-9041
Resumo
PEREZ-ALCAZAR, Keydi Viridiana et al. Complete uterine perforation caused by intrauterine device (IUD). Laparoscopic management: Clinical case report. Ginecol. obstet. Méx. [online]. 2022, vol.90, n.7, pp.616-622. Epub 26-Set-2022. ISSN 0300-9041. https://doi.org/10.24245/gom.v90i7.7022.
BACKGROUND:
Intrauterine devices are safe and effective contraceptives, although with a risk of uterine perforation if the user is not sufficiently careful and experienced. The incidence of perforation is 1 to 2 cases per thousand insertions.
OBJECTIVE:
Presentation of a case of complete uterine perforation by intrauterine device.
CLINICAL CASE:
27-year-old patient, with a history of two cesarean sections, insertion of levonorgestrel-releasing intrauterine device three months after the last one. At the outpatient clinic she reported pelvic pain, intermenstrual bleeding and two unsuccessful attempts to remove the device. Hysteroscopy showed a probable false pathway and the device was not found in the uterine cavity. The abdominopelvic CT scan located it in the left salpingeal cavity; given the suspicion of a translocated IUD, a laparoscopic procedure was decided, in which the uterus was documented with perforation on the right anterior aspect, with granulation tissue and covered by parietal peritoneum, the IUD in the cul-de-sac, oriented to the left, fixed, with lax adhesions. It was removed and, at the patient’s request, bilateral salpigectomy was performed. Histopathological study report: moderate chronic salpingitis, with fibrosis and simple paratubal serous cysts.
CONCLUSIONS:
Intrauterine devices are remarkably simple, safe and long-lasting contraceptives. In general, there is low morbidity associated with their implantation, even when uterine perforation occurs most patients experience mild symptoms: transvaginal bleeding, lower abdominal pain.
Palavras-chave : Intrauterine devices (IUD); Uterine perforation; Laparoscopy; Cesarean section.