Perforated Intra-Abdominal IUDs: A Large Case Series

Abstract

To describe the largest published series of intra-abdominal perforated IUDs to determine risk factors, methods for diagnosis, and best management of this complication. Retrospective review of surgical database at the UT Southwestern Medical Center between 1998-2011. University teaching hospital. 30 women identified through an institutional database as having a perforated IUD located in the intra-abdominal cavity. Removal of intra-abdominal IUD by laparoscopy or laparotomy. Perforated IUD was found in women 16-68 years old. 16 (53.3%) copper IUDs, 13 (43.3%) levonorgestrel, and 1 (3.3%) Lippes loop were identified intraabdominally. 16 (53.3%) women presented with abdominal pain, 14 (46.7%) were asymptomatic. 9 (40%) women were diagnosed within 1-8 weeks following IUD insertion, 3 (10%) between 2-12 months, and half (50%) 1-48 years following IUD insertion. 22 IUDs (73.3%) were inserted postpartum; 1 (3.3%) <4 weeks, 9 (30%) between 4-8 weeks, and 6 (20%) 8-12 weeks postpartum. 15 uteri (50%) were anteverted, while 10 (33%) were retroverted. 22 (77%) women underwent laparoscopy for IUD removal, 6 (20%) underwent hysteroscopy along with laparoscopy. Conversion to laparotomy was needed in 3 (10%) patients. 9 (30%) IUDs were located near the pelvic sidewall, 8 (26.4%) in the posterior cul-de-sac, 4 (13.3%) partially embedded in the myometrium, 4 (13.3%) adherent to omentum, and 2 (6.7%) on colonic epiploica. 1 (3.3%) IUD perforated the rectum resulting in recto-vaginal fistula. 4 (13.3%) IUDs were found within sterile abscesses. Dense adhesions were encountered in 17 (56.7%) women; of those 14 had copper IUDs. Perforated IUDs can cause short and long-term symptoms. Risk factors for perforation include postpartum insertion, uterine retroversion, and prior cesarean section. Long term complications include abscess and fistula formation. Copper IUDs appear to cause a greater inflammatory process than levonorgestrel IUDs. Laparoscopy should be used to locate and remove perforated IUDs.