History Of Intrauterine Device Research Articles

Abnormal uterine bleeding and associated factors among reproductive age women in Jimma town, Oromia Region, Southwest Ethiopia.

Introduction:Abnormal uterine bleeding is any bleeding that deviates from normal menstruations. It differs in terms of frequency of bleeding, duration, and the pattern of bleeding during menstrual cycle or menopause. It is a major gynecological problem for medical visits among women in the reproductive aged group. However, data on abnormal uterine bleeding in Ethiopia are limited. Therefore, this study aimed to assess the abnormal uterine bleeding and associated factors among reproductive age women in Jimma town, Southwest Ethiopia.Methods:Community-based cross-sectional study was employed from 1 January to 30 April 2020. Six hundred sixty women were selected by using systematic random sampling. Data were collected by using semi-structured questionnaires. Data were entered into EPI data version 3.1 and analyzed by using SPSS version 25 software. All predictor’s variables with p value <0.25 in bivariable analysis were entered into multivariable logistic regression analysis. Variables with a p value of less than 0.05 in the multivariable analysis were taken as statistically significant predictors of abnormal uterine bleeding.Results:Out of 660 participants, 225 (34.1%) had abnormal uterine bleeding. From women with abnormal uterine bleeding, the prevalence of metrorrhagia, heavy periods, oligomenorrhea, inter-menstrual bleeding, polymenorrhea, and amenorrhea was 59 (26.2%), 54 (24%), 53 (23.5%), 46 (20.4%), 35 (15.5%), and 25 (11.1%), respectively. History of abortion (adjusted odds ratio = 1.5, 95% confidence interval: 1.02–2.41), history of uterine fibroids (adjusted odds ratio = 3.83, 95% confidence interval: 1.85–7.94), history of sexually transmitted infection (adjusted odds ratio = 2.2, 95% confidence interval: 1.33–3.66), and the history of intrauterine device (adjusted odds ratio = 2.1, 95% confidence interval: 1.39–2.97) were significantly associated with abnormal uterine bleeding.Conclusion:The prevalence of abnormal uterine bleeding was higher in Jimma town.

Actinomycosis of bilateral psoas muscle: a case report

Actinomycosis is an underreported chronic invasive disease caused by Actinomyces spp. In that group of diseases, pelvic actinomycosis is very rare and most of the cases reported in the literature have shown unilateral psoas muscle involvement. We report a 35-year-old woman with a retroperitoneal mass located in the left psoas muscle that makes abdominal tenderness and difficulty in walking. She had a 7-year history of intrauterine device which had been removed one month just before this event. After undergoing two laparotomies to perform a biopsy with undetermined results, she developed a new mass in the right psoas muscle which was similar to the left one. On the third attempt, the histopathology revealed yellow sulfur granules of Actinomyces which reacted positively with periodic acid Schiff and Grocott’s dye. After three months of treatment with Amoxicillin plus Clavulanic acid, her abscesses were completely resolved. Actinomycosis should always be included in the diagnostic list in patients with a pelvic mass and a history of intrauterine device.

Ovarian actinomycosis mimicking ovarian malignant tumor with no history of intra-uterine device: a rare case

Background: Pelvic actinomycosis constitutes 3% of all human actinomycosis infections, and is mostly associated with an intrauterine device (IUD). Ovarian actinomycosis with no history of IUD is very rare. Case Report: A 61-year-old female presented with ovarian actinomycosis mimicking ovarian malignant tumor. The present was a very rare case of ovarian actinomycosis with no history of IUD. The patient presented with abdominal pain and mild fever for a half year. On examination, bilateral ovarian tumors suspecting ovarian malignant tumor were detected. At the operation, the authors diagnosed the patient as bilateral ovarian abscess and performed a bilateral ovarian cystectomy. The pathological examination of bilateral ovary showed ovarian abscess, and immunohistochemistry of bilateral ovary showed ovarian actinomycosis. The diagnosis was established postoperatively. Conclusion: Although diagnosis of ovarian actinomycosis is very difficult, especially in patients with no history of IUD, ovarian actinomycosis should be considered in case of suspecting ovarian malignant tumor with abdominal pain and fever persisting for a long interval.

Severe abdominopelvic actinomycosis with colon perforation and hepatic involvement mimicking advanced sigmoid colon cancer with hepatic metastasis: a case study

BackgroundActinomycosis is a rare chronic invasive disease caused by Actinomyces spp. Although abdominopelvic actinomycosis, which involves the colon and the pelvic organs extensively, has been frequently reported, abdominopelvic actinomycosis presenting with colon perforation and hepatic involvement concurrently has yet to be reported.Case presentationA 55-year-old woman presented at the emergency room with squeezing epigastric pain. Palpation of the abdomen revealed a hard mass with no acute peritoneal signs. Vital signs were normal range except for tachycardia. Initial laboratory testing revealed leukocytosis, anemia, elevated C-reactive protein (CRP), hypoalbuminemia; and normal AST/ALT and BUN/creatinine. CT scan of the abdomen-pelvis revealed a microperforations of the sigmoid colon, abscess in the left lower quadrant and hepatic lesion. Furthermore, there was a large infiltrating conglomerated mass invading the urinary bladder, left adnexa, sigmoid, left inguinal canal and left pelvic wall area. Ultrasound revealed an intra-uterine device (IUD). All these findings initially raised a suspicion of malignancy such as advanced cancer of the colon with liver metastasis. Despite the rarity of the disease, actinomycosis were not excluded because of the IUD found on ultrasound. Parenteral antibiotics and percutaneous drainage of abdomen abscess as well as fasting with total parental nutrition were prescribed for sigmoid perforation and abscess. After 10 days of conservative treatment, no remarkable change was detected in conglomerated mass invading pelvis. Furthermore, the finding of newly developed mechanical small bowel obstruction warranted surgery. Exploratory laparotomy was performed for the removal of perforated colon, obstructive small bowel and organs involved and postoperative histology confirmed a diagnosis of colonic actinomycosis. The patient made an uneventful recovery and was started on a 6-month course of penicillin.ConclusionsAbdominopelvic actinomycosis presenting with colon perforation and hepatic involvement is extremely rare; however, it is clinically similar to advanced colon cancer with liver metastasis, therefore, complicating the preoperative diagnosis. A diagnosis of abdominopelvic actinomycosis should be considered in patients with a history of IUD and chronic abdominal pain, along with an abdominal mass or cutaneous abscess. If surgery is indicated, preoperative empirical antibiotic therapy for actinomycosis and frozen biopsy during surgery may be considered.

Treatment of cutaneous actinomycosis with amoxicillin/clavulanic acid

Objective: To evaluate the efficacy and tolerability of amoxicillin/clavulanic (AMX/CLV) acid as treatment for cutaneous actinomycosis.Methods: We present a long-term follow-up study of cutaneous actinomycosis patients. Cervicofacial (CFA) and abdominal (AA) were recruited during 6 years. Diagnoses were based on clinical and microbiological characteristics; presence of granules, isolation and identification of etiological agents were carried out in each case. Patients received AMX–CLV 875/125 mg BID PO at a maximum period of 12 weeks.Results: Twenty-two cases were enrolled; the mean age was 45.2 years old. Twenty patients (91%) presented CFA and two AA (9%). All patients with CFA had dental caries, seven (35%) with periodontal disease and 10 (50%) had type-2 diabetes mellitus (T2DM). One case of AA had history of intrauterine device and other appendicitis. Granules were observed in all the cases, the main etiological agent was Actinomyces israelii 16/22 (72.7%). Clinical and microbiological cure was achieved in 19/22 cases (86.4%), the remaining patients presented clinical improvement. The average duration of the treatment was 6.6 weeks. Side effects were recorded in 4/19 cases (18.2%), three of them presented nausea and one diarrhea.Conclusion: Treatment with AMX/CLV acid showed efficacy in the management of actinomycosis with cutaneous involvement.

Xanthogranulomatous inflammation in female pelvis: a diagnostic and therapeutic challenge

Xanthogranulomatous inflammation is an unusual form of chronic inflammation that can present clinically with destructive or obstructive symptoms. It may also mimic malignancy at times. It is a rare entity as far as female genital tract is concerned. Histologically well characterized by a massive infiltration of the tissues by lipid-laden histiocytes, it usually poses diagnostic and therapeutic challenges for the clinician. We present here two interesting cases of the same, encountered by us. Case 1: A 42-year-old lady with history of intra-uterine device (IUD) in situ for 8 years presented with a picture of acute on chronic pelvic inflammatory disease (PID). She was started on inpatient CDC regimen of PID. Despite this her symptoms persisted and based on high index of suspicion she was started empirically on anti-tubercular treatment (ATT). Three months later she presented again with similar complaints. Laparotomy picture was typical of abdominal tuberculosis and thus multiple biopsies were obtained. Histo-pathological report showed xanthogranulomatous inflammation. As there is no specific treatment for this condition, patient was continued with ATT. On three, six and twelve months follow up patient had been asymptomatic. Case 2: A 48 year old lady with history of vaginal hysterectomy 6 months ago presented with right sided hydro-uretero nephrosis. CT scan showed this was because of external compression caused by an adnexal mass measuring 5.8×3.9 cms. She underwent laparotomy with right oophorectomy. Right distal ureter was fibrotic so was excised and Boari flap was done. Histopathological diagnosis rendered was Xanthogranulomatous inflammation with abscess formation and chronic ureteritis with fibrosis. Xanthogranulomatous inflammation of the genital tract is enigmatic disorder of unknown etiology. Gynecologist should be aware of this entity whenever the clinical presentation is atypical and not fitting into a diagnosis, or when the patient is not responding to conventional treatment of PID. Early diagnosis and management is very important as it can cause tissue destruction or may lead to obstructive disasters.

Predictive Markers of Tubo-Ovarian Abscess in Pelvic Inflammatory Disease

Background/Aims: The purpose of this study was to identify predictive markers for tubo-ovarian abscess (TOA) through a comparison of clinical and laboratory data in patients diagnosed with pelvic inflammatory disease (PID). Methods: We reviewed the medical charts of 499 females who were admitted to hospital with clinical, surgical, imaging-based diagnoses of PID between 2001 and 2011. The patients were divided into the following two groups: (1) PID with TOA and (2) PID without TOA. Results: The TOA and non-TOA groups were comprised of 69 and 430 females, respectively. Mean age, history of intrauterine device (IUD) insertion and inflammatory markers, including erythrocyte sedimentation rate, C-reactive protein (CRP) and CA-125 levels, were higher in the TOA group than the non-TOA group. Independent factors that predicted TOA were older age, IUD insertion, increased CRP and CA-125, and chlamydia infection. CA-125 was found to have the highest predictive value for TOA. TOA size was associated with increased surgical therapy compared to patients with smaller abscesses. Conclusions: Increased age, IUD insertion, chlamydia infection, and increased CRP and CA-125 level were the independent factors predictive of TOA in acute PID. These predictive values will be expected to help decrease gynecological morbidity by early diagnosis and appropriate treatment of TOA.

The role of three-dimensional imaging in the control of intrauterine contraceptive devices.

Dear Editor Intrauterine Contraceptive Devices (IUDs) are a form of long-term, reversible, and safe contraception, which are commonly used worldwide. A regular medical check-up is necessary to determine its position within the uterus, up to six months after IUD insertion. The complications of translocation have a wide range from displacement of IUD in myometrium to uterine perforation. Predisposing factors which are considered to be associated with dislocation include postpartum insertion, inexperienced operator insertion technique, and position of the uterus (1). Clinical history, physical examination, and transvaginal ultrasonography (US) are common procedures for the evaluation of IUDs and related complications. Although two-dimensional (2D) US (2DUS) is a routine modality in practice, it has a limited role for verifying two arms of IUD within the same plane; therefore, it may fail to detect IUD displacement (2). Furthermore, the most currently introduced hormonal IUDs can be demonstrated only by a vague shadow and might be remained unnoticed in 2DUS due to their low echogenicity (3). Recently, the availability of advanced US modalities has changed the management of IUDs by optimal evaluation of entire uterine cavity. Coronal view on three-dimensional (3D) US (3DUS) is particularly helpful to visualize the shaft and both horizontal arms in a single plane. In symptomatic patients with pelvic pain or abnormal bleeding, many IUDs, which appeared to be placed correctly or low on 2DUS, were confirmed to be imbedded, at least in part, within the myometrium with further investigations using hysteroscopy or 3DUS (4). The 3DUS is extremely useful in the management of IUDs by coronal views of the uterus and 3D-reconstructed views of the endometrium and adjacent myometrium. Many studies demonstrated the overall outstanding effectiveness of 3DUS in determining IUDs’ location, particularly for symptomatic patients with complications or patients with hormonal IUDs. Valsky et al. reported that 3DUS has a great value in symptomatic patients when the location of IUD cannot be correctly identified with traditional 2DUS (5). Bonilla-Musoles et al. designed a comparative study for the identification and location of IUDs in 66 asymptomatic women by 2DUS and 3DUS. While position of all IUDs were identified accurately with 3DUS, 2DUS failed to identify the type of IUD in 9% as well as the position of IUDs in 3%, and misidentified IUDs in 12% of patients, which was later confirmed on 3DUS (2). Lee et al. claimed the complete visualization of IUDs in 95% of patients on 3DUS vs 64% on 2DUS (6). Figure 3. In third patient, descended t-shaped intrauterine device IUD was located in the with its left arm in the cervical substance of the intrauterine device in the cervical substance (A, B). In this paper, we present 2D and 3D images of three patients with a history of IUD, placed one to three years earlier, with complaints of abdominal pain or spotting. Low positioned IUDs were identified on 2DUS. Further investigation by 3DUS was required in these symptomatic patients in order to determine the exact location of IUDs. The 3DUS was performed using 3DXI (ACCUVIX XQ, Medison, South Korea) US device with a 6.5 MHz transvaginal probe. The 2DUS and 3DUS images of patients are compared in Figures 1 - ​-33. Figure 1. In first patient, t-shaped intrauterine device (IUD) was revealed with a vertical body and flexible arms clearly not protruding beyond the confines of the endometrial echo (A, B). Figure 2. A, A low-lying of intrauterine device (IUD) in the lower uterine segment using standard two-dimensional imaging in second patient; B, The results of three-dimensional ultrasonography revealed t-shaped intrauterine device dislocated in endometrial cavity ... Comparing two images of 2DUS and 3DUS demonstrated the additional information helping in identifying the cause of abdominal pain or spotting. Sites of IUD translocation vary in terms of their clinical significance and selection of subsequent therapeutic plan. Although menorrhagia and intermenstrual bleeding have been considered as a common adverse effect of IUD placement, pelvic pain and bleeding should raise the possibility of dislodgement, perforation, or passage. The 3DUS has a crucial role in the management of both asymptomatic patients and those with suspected complications, whilst IUDs location may remain unnoticed on physical examination and 2DUS.

Differentiating pelvic actinomycosis from advanced ovarian cancer: a report of two cases, management reflections and literature review

Pelvic actinomycosis comprises a rare, subacute to chronic bacterial infection characterised by suppurative and granulomatous inflammation. Diagnosis is difficult as it may simulate pelvic malignancies. Laboratory and radiological findings are non-specific. We reported on 2 cases of pelvic actinomycosis mimicking ovarian malignancy with different management approaches that lead to opposite outcomes. We reviewed the literature on pelvic actinomycosis imitating ovarian cancer with a focus on its surgical management. Despite agreement on the duration of antibiotic therapy following surgical management, consensus regarding surgical approach was rather equivocal. We concluded that pelvic actinomycosis should be strongly suspected in women with presumed ovarian cancer of atypical presentation and a history of intrauterine devices (IUD).Electronic supplementary materialThe online version of this article (doi:10.1186/2053-6844-1-5) contains supplementary material, which is available to authorized users.

Primary Ovarian Pregnancy with intrauterine device(IUD) : a case report and reviews of the literature

Ovarian pregnancy is a rare form of ectopic pregnancy, with a reported incidence of approximately 3% of all ectopicpregnancies. We report a primary ovarian pregnancy in a 29-year-old woman with a history of intrauterine device. The patientwas admitted to the emergency department with signs and symptoms of acute abdomen with hemoperitoneum. Diagnosticlaparoscopy and pelviscopic right ovarian cystectomy were performed. On histopathological examination, products of conceptionembedded in the ovarian tissue were seen, which were confirmatory of primary ovarian pregnancy. This article is to describe acase of ovarian pregnancy and to discuss reviews of the literature.

Preoperative Diagnosis and Medical Treatment of Pelvic Actinomycosis

The diagnosis of the pelvic actinomycosis is seldom made preoperatively because of no reliable or specific clinical manifestation which has tendency to mimic advanced gynecological malignancy and the relative infrequency of the disease. To explore the method for improvement of preoperative diagnosis and possibility of avoiding the surgical management of pelvic actinomycosis, we collected and summarized the data of age, parity, state of menopause, history of intrauterine device (IUD) use, symptoms, laboratory findings, radiologic findings, provisional diagnosis and treatment from 14 cases diagnosed pathologically and treated in Hanyang University Hospital from 2000 to 2007. Eleven (78.6%) of 14 cases were IUD users. Most common complaints were lower abdominal pain (71.4%) and vaginal discharge (57.1%) which were followed by fever (28.6%) and back pain (28.6%). Four cases (28.6%) were identified as pelvic actinomycosis before operation and in 3 cases (21.4%) malignancy was provisional preoperative diagnosis. Pelvic actinomycosis was suspected via abdominal computed tomography (CT) or cervicovaginal cytology and confirmed via endometrial biopsy or fine needle aspiration biopsy. Two cases that were diagnosed before operation and received only antibiotics therapy had no recurrence. It was suggested that pelvic actinomycosis could be suspected via abdominal CT and cervicovaginal cytology in IUD users, and endometrial biopsy and fine needle aspiration biopsy may help establish the diagnosis before the operation. Adequate preoperative antibiotics therapy could make extensive exploratory surgery avoided or conservative surgery feasible.

Pelvic Actinomycosis: Is It Possible to Diagnose Preoperatively?

Purpose: Pelvic actinomycosis is a rare infection which presents difficulty in establishing a correct preoperative diagnosis. The aim of this study is to find diagnostic clues for pelvic actinomycosis preoperatively. Methods: A retrospective analysis performed at Chonbuk National University Hospital identified 9 patients with a diagnosis of pelvic actinomycosis from 1998 to 2006. Results: All patients were women with a history of intrauterine device (IUD) use. Abdominal pain (7 cases), palpable mass (3 cases), defecation difficulty (3 cases) and leucorrhea (2 cases) were the main presenting complaints. The median duration of presenting symptoms was 78 days (range: 10∼365 days). The median duration of using an IUD unchanged was 11 years (range: 4∼30 years). A correct diagnosis was made in 3 patients (33%) without exploration. All patients were treated with antibiotics after pathologic diagnosis. There was no recurrence. Conclusions: It is very difficult to diagnose pelvic actinomycosis preoperatively. Howere, if a mass or a pelvic abscess is found in women with an IUD that has been unchanged for a long time, pelvic actinomycosis should be suspected to avoid unnecessary exploration.