Lippes Loop Research Articles

Incidentally discovered extrauterine migration of a Lippes loop: should we let it stay?

Intrauterine devices (IUDs), a form of long-acting reversible fertility control, are often preferred for preventing pregnancy. The Lippes loops, made of plastic, are inserted into the uterus via the cervix, fitting into the uterine cavity. The non-medicated (inert) structure of the loop allows for long-term IUD use. Uterine perforation and translocation of the IUD are the most threatening complications. In this case report, we present an asymptomatic 79-year-old woman with a forgotten IUD that migrated into the abdominal cavity and was discovered during her follow-up for lung cancer.

Lippes loop intrauterine device left in the uterus for 40 years as a rare cause of postmenopausal pelvic pain: a case report and review of the literature

BackgroundIntrauterine devices are a widely used method of contraception worldwide. These devices are reliable, cost-effective, long-acting, and reversible. Their placement in the uterus is usually simple and safe. Forgotten IUDs carry some complications and can adversely affect the health of women. Therefore, appropriate counseling during insertion and timely removal are crucial.Case summaryWe present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. The loop was removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days.ConclusionDifferent works of the literature showed that retained Lippes loop IUD carries some complications. Our case was also presented with postmenopausal pelvic pain. Therefore, we recommend the removal of IUDs at their expiry date or menopause.

Twelve-year experience of office-setting removal of lost intrauterine devices in place for more than 10 years

Objective: We investigated the effectiveness of removing lost intrauterine devices (IUDs) that had been in place for over 10 years, using Lin's biopsy grasper in an office setting. Methods:This single-centre, retrospective study conducted between March 2006 and June 2018 included 49 women who had had an IUD in place for contraception for more than 10 years and who underwent removal of the lost IUD using Lin's biopsy grasper under transabdominal sonography without use of a tenaculum, anaesthesia and analgesia, after dilation of the cervical os and hysteroscopy. Results: The women's median age was 52 years (range 34–80 years) and the median duration of insertion was 17 years (range 10–43 years). Forty-eight (98%) women had their lost IUD removed using Lin's biopsy grasper. Among the removed IUDs, there were eight FD-1 IUDs with a string, 13 FD-1 IUDs without a string, 13 Chinese IUDs, seven Ota ring IUDs, three KS ring IUDs, two Saf-T-Coil IUDs, two Lippe loop IUDs and one Wing IUD. All women tolerated the procedure and there were no major operative complications. Conclusions: Lin's biopsy grasper was effective in removing IUDs that had been in place for a long time.

Chronic pelvic pain in a postmenopausal patient with a forgotten Lippes loop: a case report

Introduction: A calcified endometrial mass is a worrying finding in a postmenopausal patient, warranting urgent intervention. This case highlights an interesting presentation of a Lippes loop that has grown into an endometrial polyp, raising suspicion that it may have been a malignancy. Case presentation: This is a case of a 70 year old multiparous patient who presented with history of chronic pelvic pain. She could not recall insertion of the Lippes loop, and had therefore never sort to have it removed. Management and outcome: The patient underwent total abdominal hysterectomy and bilateral salpingo oophorectomy. She made a complete recovery, and histology revealed a calcified endometrial polyp. Conclusion: The Lippes loop is no longer inserted and is becoming a rare find in the practice of gynaecology. This case was an usual presentation of a Lippes loop, as the endometrial polyp had grown around the Lippes loop giving the impression of a calcified endometrial lesion.

REMOVAL OF LIPPES IUD FROM THE ABDOMINAL CAVITY AFTER 42 YEARS – CASE REPORT

Background : Intrauterine device is one of the most effective methods of contraception which in addition to many advantages also has its disadvantages. It can pass through the wall of the uterus and migrate into any tissue in the abdominal cavity. Since dislocation may be unrecognized for several years, re-examination after IUD insertion is necessary. Patients and methods : This article shows an example of a 72-year old patient with an accidentally discovered dislocated Lippes Loop IUD in the abdominal cavity. By the help of X-ray (RTG) and computed tomography (CT) we have determined its position and successfully removed it after 42 years. Conclusions : Migration and dislocation of an IUD is a rare complication and often completely asymptomatic. In order to avoid serious complications, it is necessary to re- examine patients regularly after insertion. An onset of pain certainly calls for the multidisciplinary approach in which a specialist of family medicine has the central role.

ODSTRANITEV LIPPESOVEGA MATERNIČNEGA VLOŽKA IZ TREBUŠNE VOTLINE PO 42 LETIH – PRIKAZ PRIMERA

Background: Intrauterine device is one of the most effective methods of contraception which in addition to many advantages also has its disadvantages. It can pass through the wall of the uterus and migrate into any tissue in the abdominal cavity. Since dislocation may be unrecognized for several years, re-examination after IUD insertion is necessary.Patients and methods: This article shows an example of a 72-year old patient with an accidentally discovered dislocated Lippes Loop IUD in the abdominal cavity. By the help of X-ray (RTG) and computed tomography (CT) we have determined its position and successfully removed it after 42 years.Conclusions: Migration and dislocation of an IUD is a rare complication and often completely asymptomatic. In order to avoid serious complications, it is necessary to re- examine patients regularly after insertion. An onset of pain certainly calls for the multidisciplinary approach in which a specialist of family medicine has the central role.

Evaluación del uso del dispositivo intrauterino de Lipper como método de planificación familiar

Se presentan los resultados del uso del asa grande de Lippes en 436 pacientes de un Centro de Planificación Familiar de Lima. Se tabularon 5,384 meses de uso. Se observaron 10 embarazos involuntarios (tasa de fracasos 2.21) dos de ellos con expulsión inadvertida del D.I.U. Los principales efectos indeseables fueron la leucorrea, el dolor pélvico y la metrorragia; la incidencia de expulsiones fue menor de lo referido en las publicaciones al respecto. Se ha extraído el D.I.U. por infección pélvica en 1.4 % de las pacientes. No se ha observado perforación uterina, translocación del D.I.U. ni malignización de la citología exfoliativa. Con un promedio de uso de 12.4 meses mujer existe, una tasa de abandonos del 38.8%. Se comentan estos resultados en comparación con las experiencias internacionales. Finalmente se presentan datos estadísticos que demuestran que la motivación de las pacientes por el método aumenta con su edad y paridad, no obstante incrementar paralelamente la incidencia de efectos indeseables del mismo.

Safe and cost-effective ultrasound guided removal of retained intrauterine device: our experience

ObjectivesTo evaluate the efficacy and difference in cost of ultrasound guided removal of retained intrauterine device (IUD). Study designA total of 23 women underwent ultrasound-guided retrieval of retained IUDs between January 2013 and March 2014. Transvaginal ultrasound was performed in all cases to assess the localization of the IUD. Under transabdominal ultrasound guidance, either the crochet type IUD hook (Gyneas, Goussainville, France) or Alligator forceps were used to grasp the IUD and remove it from the uterine cavity. The costs of the ultrasound guided procedure and the hysteroscopic removal of the IUD were compared. ResultsTwenty-three patients who failed IUD removal in the clinic were referred to our department for ultrasound-guided removal. All patients had an IUD present in the uterine cavity. Eleven patients had Paragard IUDs (48%), eight had Mirena IUDs (35%), three had Lippes loop (13%), and one had a ring IUD (4%). The patients’ ages ranged from 20–56 years. The IUDs were in place for 8 months to 23 years. Of the 23 patients with retained IUDs, 19 were successfully removed (83%), and 4 underwent hysteroscopic removal of IUD. The IUD removal cost in the operating room on average was $3562 US dollars and the cost of ultrasound-guided removal was $465 US dollars. ConclusionsRetained intrauterine devices with or without strings can often be safely removed in an office-based setting under ultrasound guidance at less cost than in the operating room, even in cases with embedded IUDs. ImplicationsOur experience leads us to propose in-office IUD removal under ultrasound guidance as the first line in management of retained IUDs after failed removal by conventional practices. Ultrasound provides numerous advantages including direct visualization in a less invasive manner than hysteroscopy. Three-dimensional imaging can also be used for enhanced perspective.

Lippes Loop Inserted 45 Years Back: The Dilemma to Remove It or Leave It in situ. A Case Report with Review of Literature.

IUD's like Lippes Loop (LL), intended for long term use are retained for years and menopausal ladies often present with LL in situ either deliberately or forgotten. We report a case of Lippes Loop removal inserted 45 years back in a woman complaining of post menopausal bleeding. The inserted LL thread was incidentally discovered during clinical examination and Ultrasonography. We also reviewed literature to determine the evidence for and against removal of an inert IUD.

A Rare Case of Bicornuate Uterus with Embedded Intrauterine Contraceptive Device

ABSTRACTEarly intrauterine contraceptive devices (IUCDs) like Lippes Loop were intended for long-term use until menopause and hence often retained for years, and many patients present well into menopause still bearing a Lippes Loop either deliberately or forgotten. We present a case of a 65-year-old postmenopausal female patient presented with complaints of spotting per vagina since 20 days, associated with white discharge per vagina. Ultrasound abdomen showed calcified endometrium with IUCD in the cervical canal. Hysteroscopy was done. As IUCD could be visualized but could not be removed, hence hysterectomy was done.How to cite this articleGayatri A, Nagarathnamma R, Prasad N. A Rare Case of Bicornuate Uterus with Embedded Intrauterine Contraceptive Device. J Med Sci 2015;1(4): 72-73.

Successful Conservative Management of a Dislocated IUD.

Background. Intrauterine contraceptive devices (IUDs) are widely utilized all over the world owing to their low cost and high efficacy. Uterine perforation is a rare complication that may occur at IUD insertion resulting in extrauterine location of the IUD. Traditionally, surgical removal of dislocated IUDs has been recommended. Case. A 68-year-old patient who had an IUD (Lippes loop) inserted 32 years ago and whose routine examination incidentally revealed a dislocated IUD in the abdominal cavity. The patient remained asymptomatic during three years of follow-up and the IUD was left in place. Conclusion. Asymptomatic patients, whose vaginal examinations and ultrasonography or X-ray results reveal a dislocated IUD, may benefit from conservative management.

Intrauterine contraception.

Essential facts Intrauterine contraception (IUC) methods are long-acting reversible contraceptives with licensed durations of use lasting between three and ten years. They include copper intrauterine devices (Cu-IUD), which are non-hormonal, and levonorgestrel intrauterine systems (LNG-IUS), which release levonorgestrel. They are suitable for most women, including those who have not been pregnant.

Immediate postabortal insertion of intrauterine devices.

Background The use of an effective contraceptive may be necessary after an abortion. Insertion of an intrauterine device (IUD) may be done the same day or later. Immediate IUD insertion is an option since the woman is not pregnant, pain of insertion is less because the cervical os is open, and her motivation to use contraception may be high. However, insertion of an IUD immediately after a pregnancy ends carries risks, such as spontaneous expulsion.Objectives To assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion.Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, ClinicalTrials.gov,and ICTRP in January 27, 2014. We also contacted investigators to identify other trials.Selection criteria We sought all randomised controlled trials (RCTs) with at least one treatment arm that involved IUD insertion immediately after an induced abortion or after curettage for spontaneous abortion.Data collection and analysis We evaluated the methodological quality of each report and abstracted the data. We focused on discontinuation rates for accidental pregnancy, perforation, expulsion, and pelvic inflammatory disease.We computed the weighted average of the rate ratios.We compute drisk ratios (RRs) with 95% Confidence Intervals (CIs).We performed an intention-to-treat (ITT) analysis by including all randomised participants in the analysis according to the Cochrane Handbook for Systematic Reviews of Interventions.Main results We identified 12 trials most of which are of moderate risk of bias involving 7,119 participants which described random assignment.Five trials randomised to either immediate or delayed insertion of IUD. One of them randomised to immediate versus delayed insertion of Copper 7 showed immediate insertion of the Copper 7 was associated with a higher risk of expulsion than was delayed insertion(RR 11.98, 95% CI 1.61 to 89.35,1 study, 259 participants); the quality of evidence was moderate. Moderate quality of evidence also suggests that use and expulsion of levonorgestrel-releasing intrauterine system or CuT380A was more likely for immediate compared to delayed insertion risk ratio (RR) 1.40 (95% CI 1.24 to 1.58; 3 studies; 878 participants) and RR 2.64 ( 95% CI 1.16 to 6.00; 3 studies; 878 participants) respectively. Another trial randomised to the levonorgestrel IUD or Nova T showed discontinuation rates due to pregnancy were likely to be higher for women in the Nova T group. (MD 8.70, 95% CI 3.92 to 13.48;1 study; 438 participants);moderate quality evidence.Seven trials examined immediate insertion of IUD only. From meta-analysis of two multicentre trials, pregnancy was less likely for the TCu 220C versus the Lippes Loop (RR 0.43, 95% CI 0.24 to 0.75; 2 studies; 2257 participants ) as was expulsion (RR 0.61, 95% CI0.46 to 0.81; 2 studies; 2257 participants). Estimates for the TCu 220 versus the Copper 7 were RR 0.42 ( 95% CI 0.23 to 0.77; 2 studies, 2,274 participants) and RR 0.68, (95% CI 0.51 to 0.91); 2 studies, 2,274 participants), respectively. In other work, adding copper sleeves to the Lippes Loop improved efficacy (RR 3.40, 95% CI 1.28 to 9.04, 1 study, 400 participants) and reduced expulsion(RR 3.00, 95% CI 1.51 to 5.97; 1 study, 400 participants).Authors' conclusions Moderate quality evidence shows that insertion of an IUD immediately after abortion is safe and practical. IUD expulsion rates appear higher immediately after abortions compared to delayed insertions. However, at six months postabortion, IUD use is higher following immediate insertion compared to delayed insertion.

Perforated Intraperitoneal Intrauterine Contraceptive Devices: Diagnosis, Management, and Clinical Outcomes

Study ObjectiveTo describe a series of intraperitoneal perforated intrauterine contraception devices (IUDs) and to discuss associated findings, methods for diagnosis, and management of this complication. DesignRetrospective review of surgical database between 1998 and 2012 (Canadian Task Force classification II-2). SettingUniversity medical center. PatientsThirty-seven women with a perforated IUD in the intraperitoneal cavity. Measurements and Main ResultsNineteen copper IUDs (51%), 17 levonorgestrel-releasing IUDs (LNG-IUDs) (46%), and 1 Lippes loop (3%) were identified. Twenty women (54%) had abdominal pain, 16 (43%) had no symptoms, and 1 (3%) was found to have strings protruding from her anus. Twenty-six women (70%) underwent laparoscopy to remove the IUD, and 6 (16%) underwent hysteroscopy along with laparoscopy. Conversion to laparotomy was required in 4 patients (11%). Two IUDs (5%) caused full-thickness rectouterine fistulas that required laparotomy for repair. Dense adhesions were found in 21 women (57%); and of those, 15 (71%) were associated with a copper IUD. Copper IUDs were significantly more likely than LNG-IUDs to be associated with dense adhesions (p = .02). ConclusionsPerforated IUDs can be asymptomatic or cause short-term and long-term symptoms. Long-term complications include abscess and fistula formation. Copper IUDs cause a greater inflammatory process than do LNG-IUDs. Even if asymptomatic, we advocate prompt removal of all IUDs that perforate into the peritoneal cavity once they are identified. Laparoscopic surgical removal of an intraperitoneal IUD is a safe and preferred method.

Office management of lost intrauterine devices either with or without strings

To evaluate the efficacy of our method for retrieval of lost intrauterine devices (IUDs) either with or without strings in an office-based setting. A total of 38 women underwent retrieval of lost IUD. After preevaluation with ultrasonography and hysteroscopy, a Lin polyp grasper was used to remove the IUD under ultrasound monitoring without using a simultaneous hysteroscopy. Out of 38 women, 12 (31.6%) had IUD insertion for 10–19 years, whereas in another 12 women (31.6%), the duration was 20–40 years. Participants were divided into two groups: (1) premenopausal group ( n = 21). The removed IUDs were 11 Chinese IUDs, seven FD-1 IUDs, one Yusei ring IUD, one Lippe loop IUD, and one Mirena IUD; and (2) postmenopausal group ( n = 17). The removed IUDs were five soft type Ota ring IUDs, eight FD-1 IUDs, one Saf-T-Coil IUD, one KS wing IUD, and one Chinese IUD. A very hard type Ota ring IUD inserted for 40 years could not be removed. All of the other IUDs were removed uneventfully. Most of the patients could tolerate the procedure without the use of analgesia or anesthesia. No subsequent complication except bleeding for several days was encountered. Using our method, lost IUDs either with or without strings can be effectively and safely retrieved in the office-based setting without analgesia or anesthesia.

Letter to the Editor Report of surgical correction of a cervicovaginal agenesis case: cervicovaginal reconstruction with pudendal thigh flaps

Letter to the Editor Report of surgical correction of a cervicovaginal agenesis case: cervicovaginal reconstruction with pudendal thigh flaps

Peritoneal Carcinomatosis with Displaced IUCD

Abstract: Intrauterine contraceptive device (IUCD) has been widely used as a safe, economic, effective and reversible method of contraception. IUCDs are generally well accepted with good compliance but complications sometime occur. Uterine perforation is a rare complication with an incidence of one in 1000 procedures. Whether a displaced IUCD in the peritoneum can lead to carcinogenesis is a matter of debate. We report a case of peritoneal carcinomatosis with displaced Lippes loop. A 70 year female with ascites who was diagnosed as peritoneal carcinomatosis and administered two cycle of chemotherapy presented to this institution for further management. She was evaluated, administered four more cycles of chemotherapy and taken for exploratory laparotomy. At laparotomy a Lippes loop was found adherent to the colon and omentum. Total abdominal hysterectomy, bilateral salpingo-oopherectomy, total omentectomy and transverse colon resection with end to end anastomosis was done. Post operative histopathology showed adenocarcinoma in colon and omentum located around the loop. Uterus, ovaries and rest of the bowel were free of disease. She received two more cycles of chemotherapy after operation. She has completed follow up of 6 weeks after completion of treatment with clinically no evidence of disease.

Review of intrauterine adhesiolysis at the Aminu Kano Teaching Hospital, Kano, Nigeria

Hysteroscopic adhesiolysis is shown to significantly improve the outcome of intrauterine adhesions (IUA). The Minimally Invasive Surgical Unit (MISU) of our Department recently acquired a hysteroscope which is being used for hysteroscopic adhesiolysis among others. There were 57 patients diagnosed to have IUA of which 54 case notes were available for analysis, giving a retrieval rate of 95%. The information extracted includes age, parity, and menstrual pattern, predisposing factors, treatment option, outcome, complications and the year of the procedure. The data extracted were analyzed using Epi info Version 3.4.1. Chi squared test (Fisher's exact test) was used to test for statistical difference in the outcome of the modalities of treatment. P value of less than 0.05 was considered significant. There were 57 cases of IUA out of 4160 gynecological patients seen, giving a prevalence of 14/1000. The mean age was 28.9 years (SD 4.5) and mean parity was 1.4 (SD 1.4). Etiologic factors include Dilatation and curettage (D and C) (33.3%), Caesarean section (C/S) (31.5%), manual removal of placenta and Pelvic Inflammatory Disease (PID) (7.4% each), and unexplained (3.7%). Mode of presentation was secondary amenorrhoea (50%), oligomenorrhoea (22.2%), and hypomenorrhoea (10%). As for the management, 68% had blind procedure while 25.9% had hysteroscopic procedure. Lippes loop was used in all except three patients who had pediatric Foleys catheter instead. Upon follow-up 59.3% resumed normal menses, 11.1% had oligomenorrhoea, hypomenorrhoea 13% and amenorrhoea 5.6%. There was no statistical difference in the outcome of treatment between hysteroscopic adhesiolysis and the blind procedure when return to normal menses is considered as the end point, OR=2.27, CI 0.45-12.65, Fisher exact test (one-tailed) P=0.2184818. There was no significant difference between the blind and hysteroscopic procedures. Dilatation and curettage was found to be the commonest cause of IUA.

Forgotten intrauterine devices presenting with pre- and postmenopausal bleeding: a case series

We present two cases of retained intrauterine contraceptive devices (IUCDs). The first presented with perimenopausal bleeding and dysmenorrhoea and the symptoms were resolved following the removal of an IUCD. The second presented with postmenopausal bleeding and had a Lippes loop in the uterine cavity. The symptoms resolved after the removal of the device.

Perforated Intra-Abdominal IUDs: A Large Case Series

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.