1454 Intrauterine Device Perforation and Adhesion Formation

Abstract

Study Objective To compare the potential for adhesion formation between metal containing and levonorgestrel releasing IUD, once uterine perforation occurred. Design PubMed electronic search with key words and subject heading “intrauterine device” and “perforation” was performed Setting N/A Patients or Participants 75 articles, describing 85 cases, between 1965 to 2016 were included in the study. Interventions Patient demographics, class of IUD, site of adhesion formation and the description of these adhesions were tabulated. Adhesions were classified into 3 groups (Group I, II and III) based on the degree of the adhesions (dense/severe to filmy). The degree of intra-peritoneal adhesion formation and the class of IUD was analyzed. The statistical test to analyze the contingency table for the three groups was Chi square test. The p value of Measurements and Main Results Metal containing perforated devices were found to have a statistically higher number of dense adhesions compared to levonorgestrel releasing IUD (p=.000056). The sigmoid colon (22%) was found to be the most common site of adhesions formation following perforation of IUD. Laparotomy was performed in the majority of cases in which a metal containing IUD had perforated. Conclusion The degree of intra peritoneal adhesion formation is significantly higher in metal containing perforated IUD, and this may contribute to further complications such as visceral perforation, bowel obstruction and need for more extensive procedures such as appendectomy or bowel resection. Further studies are warranted to establish the significance of this in patient selection criteria.