Radiographic aspects of perforated intrauterine contraceptive devices.

Abstract

Small intestinal obstruction secondary to a perforated intrauterine contraceptive device (IUD) has been rarely reported and was not considered in many earlier reviews on the complications of these devices, although uterine perforation is a well recognized though infrequent complication. Some radiographic features of IUD perforation have only recently been considered (8). In Hall's analysis (12) of 19 proved cases of IUD perforation at the Sloane Hospital for Women he listed 2 associated with intestinal obstruction. Since his report, 3 additional cases of uncomplicated perforation have been diagnosed. The purpose of this paper is to assess the radiographic features of the 22 cases of uterine perforation and to present this entity as a possible cause of intestinal obstruction. Case Reports Case I: A 34-year-old Caucasian female, gravida VII, Para VI, had a Birnberg bow inserted in 1964, five weeks postpartum. With no history of its expulsion, she subsequently delivered a normal full-term infant in September 1966. In November 1966 another intrauterine device was inserted at the patient's request. A film of the abdomen on Dec. 6 demonstrated the two intrauterine devices (Fig. 1, A). The second device, a coil, was removed. A hysterosalpingogram showed the bow to be completely out of the uterine cavity. Although scheduled for admission for removal of the bow, the patient did not return until April 1967. At this time she complained of diffuse, crampy abdominal pain with nausea and vomiting of one-day duration. Physical examination disclosed a distended abdomen, generalized tenderness, and hyperactive bowel sounds. Supine and erect films of the abdomen (Fig. 1, B) demonstrated small intestinal obstruction (mechanical ileus). The bow had migrated from its pelvic position to the right upper quadrant of the abdomen. The caudal aperture of the contraceptive device was distorted so that the base of its triangle was bowed convexly. At operation the intrauterine contraceptive device was free in the peritoneal cavity. A small knuckle of one wall of a loop of the terminal ileum was herniated through one of the apertures of the bow causing proximal obstruction (Fig. 1, C). No gangrenous bowel was seen, and the bow was merely removed without bowel resection. The postoperative course was uneventful. Case II: A 28-year-old Negress, gravida IV, Para II, with no history of previous surgery had a Birnberg bow inserted six weeks postpartum, in 1963. With no history of expulsion of the device she became pregnant and had a spontaneous abortion in June 1964. In March 1965 a local physician attempted to remove the device. She became pregnant shortly thereafter and experienced a normal spontaneous delivery in December 1965.