English

Abstract

Intestinal injury following uterine perforation is a serious complication of intrauterine device (IUD) application. It can be in the form of obstruction, perforation or ischemia leading to stricture or fistulae formation. Perforation commonly involves sigmoid colon followed by the small intestine and rectum. Acute complications like peritonitis may occur sometimes leading to death. These complications commonly occur during insertion. Very rarely it may occur during the IUD removal. We are reporting an unusual case of small intestinal (ileum) injury during IUD removal leading to peritonitis. KEY-WORDS: Intrauterine devices, Intestinal injury, Perforation, Peritonitis INTRODUCTION: One of the most serious complications associated with the insertion of intrauterine devices (IUD) is uterine perforation. The reported incidence of uterine perforation ranges from 0.05to 13 per 1,000 insertions, varying according to several factors related to the patient, operator and IUD(1-2)The factors associated with uterine perforation are the type of IUDs, the timing of insertion with respect to the termination of pregnancy, the position i.e. anatomy of the uterus, the insertion technique, and the experience of the person inserting the IUD.(3) Uterine perforation can be iatrogenic, during the insertion, by the applied mechanical force (primary perforation) or spontaneously afterward (secondary perforation). Fifteen percent of uterine perforations involve adjacent organs, usually the small or large intestines.(2) IUD-related complications involving the intestines include obstruction, perforation, ischemia, mesenteric injury, stricture and fistulae.(3) Although intestinal injuries occur during insertion, it is unusual during removal of IUD. We are reporting a case of small intestinal perforation during removal of a copper T380A IUD. THE CASE: A 27-year-old, para 1 female was admitted in our hospital with history of severe pain abdomen, fever and abdominal distension for 4 days. She had history of an IUD (copper T380A) insertion one year back in an outside hospital immediately after her first delivery. Her menstrual periods were regular with heavy bleeding and pain for which she wanted to remove the IUD. Last menstrual period was 15 days back. The IUD was removed 4 days back in the same outside hospital. She experienced some difficulty during the process of removal. It was manipulated with instruments and she had severe pain and minimal vaginal bleeding during the process. Next day she had severe pain abdomen for which she again visited the same hospital. She was prescribed analgesic and advised to take rest. However, since the pain, fever and abdominal distension persisted in spite of medication, she visited our hospital