Abstract
A woman who had a copper 7 coil inserted without difficulty, in 1978 decided to have another baby, and in February 1980, she asked for the device to be removed. Her (GP) general practitioner could not find the threads so she was referred to me. She did mention to her GP that she had noticed the threads appearing at her anus after defecation. The GP did a rectal examination and reassured her, suggesting that she had a vivid imagination. I saw her later that month and found no abnormality apart from a retroverted uterus and could not feel the coil with the uterine sound or hook within the uterine cavity. An X-ray of the abdomen showed that the IUD was identifiable in the midline front of the sacrum, and would appear to be in the uterus. In May 1980, she was admitted to hospital for removal of the coil. She told my senior house officer that she had felt the strings rectally: this observation was dismissed and not recorded in the notes. At operation I found a normal pelvis with retroverted uterus but no coil. Laparoscopy revealed no adhesions and no evidence of pelvic infection, but something seemed to be distorting the cavity of the sigmoid colon. It was then that my senior house officer mentioned that it was this patient who had thought she had felt the strings coming out of the rectum. She was asked to return as an outpatient 2 weeks later for sigmoidoscopy, after full bowel preparation. On sigmoidoscopy, the coil threads were readily visible and the copper 7 was found embedded 1/2 under the mucosa of the sigmoid colon at 17 cm. I grasped the free end with biopsy forceps and withdrew the coil, considerable force being needed. I prescribed ampicillin and metronidazole for 4 days and warned her about possible complications. However, the procedure caused no discomfort and there were no complications. Assuming the coil had been inserted into the uterine cavity, it it suprising that it had perforated the uterus and the sigmoid colon without causing pelvic sepsis and withoutt leaving adhesions. Edelman et al., in their review found 10 cases of bowel perforation with IUDs (4 Dalkon shields, 3 Lippes loops, and 3 copper T's or copper 7's). All cases presented with pelvic sepsis apart from 1 case of small bowel perforation with a Dalkon shield, but even then at laparotomy extensive adhesions were found between the fundus of the uterus and the small bowel in which the coil was embedded.
Published Version
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