Uterine Perforation Research Articles

SONOGRAPHIC DETECTION OF UTERINE PERFORATION IN SURGICAL ABORTIONS: CASE REPORT FROM A DEVELOPING COUNTRY.

Uterine perforation is a rare major complication of surgical abortion which can be detected by ultrasound. In the last four decades, over 70% of case reports on uterine perforation in surgical abortions were from developing countries. Yet ultrasound was rarely used in detecting uterine perforation. This case report presents two cases of uterine perforation in surgical abortions which were detected by ultrasound prior to laparotomy. In the first case, a 34-year old woman was referred to our facility as a case of hypovolaemic shock following termination of pregnancy. An ultrasound examination performed to exclude an intra-abdominal abscess collection revealed a 1.2cm defect in the fundal region of the uterus with extrusion of abdominal contents into the endometrial cavity through the defect. In the second case, a 31-year old woman presented with a history of vomiting, abdominal pain, abdominal distension and absolute constipation after undergoing an evacuation of the uterus for a spontaneous abortion at 7 weeks’ gestation. Transabdominal ultrasound showed a defect of 1.4cm wide at the fundus of the uterus, with a structure extending from the abdominal cavity through the defect and into the endometrial cavity. It also showed distension of multiple bowel loops within the abdominal cavity. Sonographic detection of uterine perforation led to appropriate management in both cases. In developing countries, where the incidence of major complications of abortion is still very high, utilizing ultrasound can be helpful in detecting complications such as uterine perforation.

Radiation Dose in the Uterine Perforation by Tandem in 3-Dimensional Cervical Cancer Brachytherapy

Cervical cancer patients may sometimes experience different types of uterine perforation by a tandem during brachytherapy. The purpose of this study was to address possibly different management strategies regarding different tandem positions from a dosimetry aspect by evaluating radiation doses delivered to organs-at-risk (OAR) in order to help medical professionals handle different types of uterine perforation. Images and dosimetry data in cervical cancer brachytherapy with uterine perforation were reviewed. Uterine perforation was classified into anterior and posterior perforation according to their tandem positions. Radiation doses received by OAR, including D2cc and D1cc of the bladder, rectum, and sigmoid colon, were statistically compared with nonperforation. The doses of high-risk clinical target volume (HR-CTV) of cervical tumor and bilateral point A were also compared in order to assure that the plans had not compromised the treatment efficacy. A total of 21 applications were assessed, including 5 with anterior perforation, 4 with posterior perforation, and 12 without perforation. In anterior perforation, the bladder was the only organ that received a significantly increased dose about 30% at D2cc and D1cc. However, in posterior perforation, multiple OAR received significantly excessive doses: approximately 30% for the bladder, 37% for the rectum, and 100% for the sigmoid colon. The OAR dose assessment was based on a statistically equivalent cervical tumor dose. Different management strategies are possible for anterior vs posterior perforation during brachytherapy due to different detrimental extents on OAR dosimetry. The bladder warrants more attention in anterior perforation, without compromising target coverage in treatment planning. On the other hand, repositioning may be considered in posterior perforation due to relatively massive OAR detriments. This concept is a new one and is given for the first time.

Once treated, twice harmed: A case report of acquired gynatresia following vaginal insertion of herbs

Gynatresia is the narrowing or complete occlusion of the vagina, which may be congenital or acquired. In Nigeria, acquired gynatresia is more common, usually resulting from the use of herbal pessaries. Its mere occurrence is indeed one social calamity to many. We present a case of a 37-year-old P0+1 with acquired gynatresia following insertion of herbal pessaries at a trado medical center. This was in an attempt to treat cryptomenorrhea which had developed following an abortion complicated by uterine perforation at a private hospital 20 years prior. Poor quality of medical care may push women to seek unsafe alternatives, resulting in even more harm.

Bladder and uterine perforation after dilatation and curettage leading to high serum creatinine

Bladder and uterine perforation after dilatation and curettage leading to high serum creatinine

Acute Genital Peritonitis in Brazzaville, Congo

Genital peritonitis is rare in daily surgical practice in Congo-Brazzaville. Clandestine abortions are incriminated. The purpose of the study is to analyze the epidemiological, etiological, diagnostic and therapeutic aspects of genital peritonitis. A retrospective and case series study was realized in departments of Digestive Surgery and Gynecology-Obstetrics of the University Hospital of Brazzaville. The inclusion criteria for the diagnosis of peritonitis were abdominal pain, fever, transit disturbances and signs of peritoneal irritation. The parameters studied were: age, etiological circumstances, anatomical lesions, type of surgical treatment and evolution. During the study period (July 1, 2015-December 31, 2017), 306 patients were admitted to both departments for acute generalized peritonitis. Among them, a genital cause was incriminated in 18 (5.9%) patients. The mean age was 27.6 ± 3.1 years. At the parity and gestational level, 93% of patients had at least two pregnancies, but not more than the second trimester. In addition, 50% of the patients had an induced miscarriage, due to uterine and intestinal lesions. Induced miscarriages accounted for half of etiological circumstances. Physical examination of the abdomen revealed abdominal contracture in 61.1% of cases. Main visceral lesions were uterine perforation (55.5%) followed by rupture of tubo-ovarian abscess (38.9%). The operative follow-up was simple in 83.33% of cases. In conclusion, genital peritonitis remains unfrequented. Median laparotomy has been the main therapeutic approach in our context where emergency laparoscopic surgery is not yet common.

Comparison of intravaginal misoprostol and intramuscular carboprost for cervical priming in the first trimester of medical termination of pregnancy

Background: Suction evacuation is a widely used method for elective termination of pregnancy in the first trimester. The step of mechanical cervical dilatation during this procedure is probably the most critical step. Difficult cervical dilatation may cause incomplete evacuation, cervical laceration, and uterine perforation. Prior cervical priming with pharmacological agents like prostaglandin derivatives, although not free from side effects, makes the procedure easier with reduced overall complication rate and hence recommended in several guidelines. Aim: The aim of the study was to compare, two prostaglandin derivatives, intravaginal misoprostol (15-deoxy-16-hydroxy 16-methylprostaglandin E1) with intramuscular carboprost (15-methyl prostaglandin F2α) for cervical priming prior to suction evacuation in the first-trimester termination of pregnancy. Settings and Design: A prospective study was conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra. Materials and Methods: Eighty women requesting pregnancy termination from 6th to 12th week gestation were randomized into two groups. Two hours prior to suction evacuation, the first group (n = 40) received 400 μg of intravaginal misoprostol, while the second group (n = 40) received 125 μg of intramuscular injection carboprost. The outcomes of both the groups were recorded in terms of baseline cervical dilatation, immediate complications, drug-induced side effects, and patient's acceptability by questionnaire. Results: The “mean baseline cervical dilatation” prior to suction and evacuation in the misoprostol group was 8.11 ± 0.95 mm in the carboprost group was 6.25 ± 0.06 mm which is highly significant (t = 7.02, P 8 mm, compared to 17.5% in carboprost group (P = 0.004). The side effects including nausea, vomiting, and abdominal cramps were more in carboprost group as compared to the misoprostol group. No patient had diarrhea in misoprostol group as against 32.5% in carboprost group (P

A 5-Year Retrospective Study on the Use of Manual Vacuum Aspiration in the Federal Teaching Hospital Abakaliki

Introduction: Since the inception of our hospital in 2011, manual vacuum aspiration has been in use for the treatment first trimester miscarriages. Hence there is a need for operational review on its use. Aim: The aim of this study is to evaluate the determinants and outcome of Manual Vacuum Aspiration (MVA) use in our hospital. Method: This was a retrospective study on the use of MVA for various indications in our facility over a 5-year period. Results: There were 625 (19.7%) manual vacuum aspirations among 3179 gynaecological patients seen during the period. The age range of the women was from 15 to 48 years and the mean age was 28.5 ± 5.3 years. Incomplete abortion was the commonest indication for the use of MVA and accounted for 89.9% of cases. Other indications for the use of MVA include missed miscarriage (1.8%), and blighted ovum (1.8%). The complications were uterine perforation (0.3%), infection (3.7%) and severe anaemia (10.7%). The mean total hospital stay was 1.6 ± 0.6 days. Overall, 267 (42.7%) patients were managed as a day case. Conclusion: Manual vacuum aspiration is an effective tool in the management of early pregnancy complications. It is a safe, easily performed and possibly cost-effective procedure, with advantages for both the patient and the health care system.

Postpartum intrauterine contraception device, a method of contraception: A study from rural north India

Background: PPIUCD is not commonly used in developing countries because of lack of awareness, social taboos and fear of complications of IUCD devices. Low acceptance of immediate PPIUCD usage results in high unmet needs and low utilization of the contraceptive method. Therefore we planned this study to see the acceptability and safety of PPIUCD in our local population. Material & Methods: A cross sectional, prospective study was conducted on 2540 women attending antenatal clinic at District hospital Samba, Jammu; Jammu and Kashmir from March 2016 to February 2018. All women attending antenatal clinic and in labour room were counseled for immediate PPIUCD and after written consent were included in the study. All these women were called for follow up visit after 6 weeks of insertion of PPIUCD. Results: A total of 2540 women were counseled for PPIUCD during their antenatal visits in third trimester and in early labour. Out of which 811 (31.9%) PP IUCD insertions were done. Most common age group was 26 – 30 year. Most of PPIUCD insertions were done in vaginal deliveries i.e. 678(83.6%) out of 811 and intracesarean PPIUCD insertions were only 133(16.40%) out of 811. Most of the women were either Para 2 or Para 1. 396 (48.82%) women came for follow-up after 6 weeks. There was no case of uterine perforation or any unplanned pregnancy. Unusual vaginal discharge were reported by 76(19.19%) women at follow-up. In 32 women IUCD was removed because of heavy menstrual loss, PID and personal reasons. IUCD strings were not seen on per vaginum examination in 40(10.10%) cases. All women with undescended strings underwent ultrasonographic confirmation of intrauterine placement of the device and women were assured for continuation of PPIUCD. Conclusion: To achieve the goal of Health Services for all, all women should have access to family planning services. If family planning services are provided to all women then only we will be able to decrease maternal and infant mortality. Acceptance of PPIUCD as method of contraception is low, though PPIUCD is an effective, safe, rapidly reversible and convenient contraceptive method. PPIUCD should be encouraged considering the advantages that come along, although there is a relatively higher incidence of expulsions

A discussion on “Serosal prolapse through vagina: A rare presentation of uterine perforation following a surgical abortion”

A discussion on “Serosal prolapse through vagina: A rare presentation of uterine perforation following a surgical abortion”

Endometrial polyps: optimization of anti-inflammatory therapy

The frequency of hyperproliferative pathology of endometrium is about 60–70% in the structure of gynecological pathology of postmenopausal women. Endometrial polyps are a fairly frequent gynecological pathology for women of all ages, but the overwhelming majority of them are diagnosed at the age of 40–60 years. According to a number of studies, the frequency of endometrial polyps is 39.2–69.3%, and the endometrial polyposis occupies the first place in the structure of intrauterine pathology in postmenopausal. Given the important role of inflammation in the etiology of endometrial polyps and the risk of infectious complications in the postoperative period, there is a need for a comprehensive approach to the examination and treatment of this pathology. To date, ultrasound diagnostics and hysteroscopy are considered the standard for diagnosing endometrial polyps. However, the use of hysteroscopic technique in postmenopausal patients has a number of limitations, which are primarily associated with the possible occurrence of anesthetic and surgical complications. With age in the body, women experience atrophic changes in the genital area, which are often the cause of the formation of stenosis and obliteration of the cervical canal, which increases the risk of injury during his burying and can lead to the formation of a «false» course and even perforation of the uterus. This causes a more complicated postoperative period, which is characterized by a pain syndrome, the presence of subfebrile, hematometry, etc. In addition, given the growth in postmenopausal frequency of extragenital pathology and metabolic syndrome, during the surgical interventions and in the postoperative period, the risk of thrombotic complications increases. The article presents the substantiation of the expediency of conducting anti-inflammatory therapy in the postoperative period in postmenopausal patients after hystero-rectoscopic removal of polyps. The risk of complications of inflammatory nature after hysteroscopy is quite high and is 3–10%. The expediency of using the combined treatment regimen of endometrial polyps in this patient population using the enzyme complex Distreptaza®, which reduces the severity and duration of the pain syndrome, reduces the risk of developing subfebrile and formation of hematometry.

Laparoscopy for evaluation of infertility patients in a tertiary center in north-eastern Nigeria

Laparoscopy uses fiber optic endoscope passed through the abdominal wall to visualize the peritoneal cavity for both diagnosis and therapy; it is also referred to as Minimal Access Surgery. It is an important tool in the evaluation of infertility. The objective of this study is to determine the value of laparoscopy for evaluation and treatment of infertility patients in Bauchi. North east, Nigeria. This is a retrospective cross-sectional study of women who had evaluation using laparoscopy. The case files and theatre records of all the women who had laparoscopy over a 5-year period between the 21st February, 2012 and 20th January, 2017 were retrieved and analyzed. Data on age, parity, type of infertility, intra operative findings and type of procedures done were extracted using a proforma. Analysis was done using statistical package for social sciences (SPSS version 21, IBM). One hundred and thirty-seven women had laparoscopy and or hysteroscopy during the review period, retrieval rate was 98%. Mean age was 29 years ±SD. Median number of pregnancies was 2. Most of the women had laparoscopy for secondary infertility indicated by tubal or an ovarian factor. Thirty-two (32) women (23.4%) had normal study. Sixteen (16) interventional procedures (12%) were done during the study period ranging from ovarian cystectomy, adhesiolysis, salpingectomy and sterilization. There were nine (9) congenital abnormalities detected during the period. Fifteen (15) women had both hysteroscopy and laparoscopy. Three women (2.8%) had uterine perforation with only one converted to laparotomy giving an overall success of 97%. Laparoscopy has changed the perception of many gynecologists in the diagnosis and treatment of infertility from mere imaginative to definitive thoughts.

Effectiveness of Hysteroscopic Techniques for Endometrial Polyp Removal: The Italian Multicenter Trial

Study ObjectiveTo compare the effectiveness and safety of different techniques of hysteroscopic polypectomy. DesignMulticenter, prospective observational trial (Canadian Task Force classification II-2). SettingNineteen Italian gynecologic departments (university-affiliated or public hospitals). PatientsConsecutive patients suffering from endometrial polyps (EPs). InterventionsHysteroscopic polypectomy, as performed through different techniques. Measurements and Main ResultsIncluded in the study were 1404 patients (with 1825 EPs). The setting was an ambulatory care unit in 40.38% of the cases (567 women), of whom 97.7% (554) did not require analgesia/anesthesia. In the remaining 59.62% of women (837 women), the procedures were performed in an operating room under mild sedation, local or general anesthesia. Minor complications occurred in 32 patients (2.27%), without significant differences between the techniques used (p = ns). Uterine perforation occurred in 14 cases, all performed in the operating room with some kind of anesthesia, only 1 with a vaginoscopic technique and the remaining during blind dilatation (odds ratio [OR], 19.98; 95% confidence interval [CI], 1.19–335.79; p = .04). An incomplete removal of EPs was documented in 39 patients. Logistic regression analysis showed that a higher risk of residual EPs was associated with the use of a fiber-based 3.5-mm hysteroscope (OR, 6.78; 95% CI, 2.97–15.52; p <.001), the outpatient setting (OR, 2.17; 95% CI, 1.14–4.14; p = .019), and EPs located at the tubal corner (OR, 1.98; 95% CI, 1.03–2.79; p = .039). No association between incomplete EP removal and EP size or number was recorded (p = ns), as well as with the other variables evaluated. ConclusionOutpatient polypectomy was associated with a minimal but significantly higher risk of residual EPs in comparison with inpatient polypectomy. Conversely, inpatient polypectomy was associated with a considerably higher risk of uterine perforation and penetration in comparison with office hysteroscopy. Because of lower intraoperative risks and higher cost-effectiveness, office hysteroscopy may be considered, whenever possible, as the gold standard technique for removing EPs.

Retained Intrauterine Device (IUD): Triple Case Report and Review of the Literature

Background Throughout the world, intrauterine contraceptive devices (IUDs) are a frequently used, reversible, popular contraceptive method. They are usually placed without major complications. Uterine perforation is a rarely observed complication. Migration of the IUD to the pelvic/abdominal cavity or adjacent structures can occur after perforation. We present 3 cases of uterine perforation, possibly due to scarred myometrium associated with a cesarean delivery. We describe 3 perforations with IUDs lodged in the bladder serosa, the posterior cul-de-sac, and tissue adjacent to the cardinal ligament and external iliac artery. Cases Case 1. 26-year-old, Gravid 4, Para 2113, nonpregnant female with a history of a cesarean delivery underwent placement of an IUD one year after an elective pregnancy termination, presenting with abdominal pain requesting removal of the IUD. On speculum, although the IUD strings were visualized, the IUD could not be removed. Sonogram imaging identified an empty endometrial cavity with the IUD in posterior cul-de-sac. The IUD was removed via laparoscopy. Case 2 34-year-old Gravida 5, Para 4004, at 27 weeks and 3 days gestation, female with history of two previous cesarean deliveries underwent a third cesarean after spontaneous rupture of membranes with comorbid chorioamnionitis. Reproductive history was significant for placement of an IUD that had not been removed or imaged during obstetrical sonograms. The clinical evaluation revealed that the IUD had been spontaneously expelled. On the fifth operative day, the patient is febrile with CT demonstrating the IUD penetrating the anterior surface of bladder. On cystoscopy the bladder mucosa was intact. The IUD was removed via laparotomy with repair of the bladder, serosa, and muscular layer. Case 3 26-year-old, Gravid 4, P3013, nonpregnant female with three previous Cesarean deliveries had an IUD in place. However, with the IUD in situ, the patient conceived and had a spontaneous abortion. After the spontaneous abortion, she presented to clinic to have the IUD removed due to pain that was present since placement. Although the IUD strings were visualized, attempts to remove it were unsuccessful. Imaging identified the IUD outside the uterine cavity. Palpation with a blunt probe laparoscopically revealed a hard object within the adhesion band, close to the cardinal ligament. As per radiology evaluation, IUD was embedded 1cm from the external iliac artery on the right side outside the uterus in the adnexal region. A multidisciplinary procedure with gynecologic-oncologist was scheduled for removal due to the high risk of perioperative bleeding. Conclusion Patients in whom uterine perforation and IUD migration are suspected should have appropriate evaluation that includes transvaginal or transabdominal ultrasound or radiographs to confirm the position of the IUD, regardless of whether they are asymptomatic or present with symptoms. It is particularly important in the presence of a scarred uterus that imaging is used to identify the location of a missing IUD. The uterine scar of a cesarean may facilitate migration of the IUD. Cross sectional imaging, such as CT or MRI scan, may be needed to rule out adjacent organ involvement before surgical removal.

Casuistic cases of migration of the intrauterine device

The purpose of this article is to provide information of isolated cases of migration of intrauterine contraceptive devices (IUD), familiarity with them will be useful in medical practice. In analyzing the medical literature related to the migration of the IUD, a large range of ectopic spirals and a variety of clinical manifestations attract attention. Usually setting the IUD is not difficult. However, complications can sometimes occur: infection, uterine bleeding, ectopic pregnancy, and uterine perforation. This does not happen very often, but at the same time there are potentially serious complications. In cases of complete perforation, the IUD may migrate to various intra-abdominal structures. Thus, according to the analysis of medical literature, most often the IUD migrates into the greater omentum (26.7%), Douglas space (21.5%), the lumen of the colon (10.4%), myometrium (7.4%), wide ligament of the uterus (6.7%), abdominal cavity (5.2%), small intestine (4.4%), large intestine (3.7%), bladder, groin, ovaries, fallopian tubes. Women with chronic pelvic pain on the background of an established IUD should be carefully examined for possible uterine perforation or intrauterine migration. In the differential diagnosis of the causes of pain syndrome, the main role is played by ultrasound examination and hysteroscopy, which allows you to accurately determine the position of the IUD in the uterus or outside it. However, in cases of partial migration, additional clarifying diagnostic methods are used. Computed tomography is effective for determining the location of the IUD, its relationship with neighboring structures, and allows to evaluate other possible causes of dysfunction of the urinary tract. All modern IUDs are radiopaque, therefore, to determine their localization is also used survey X-ray. The range of methods for extracting migrated IUDs is quite diverse, but endoscopic techniques are priorities. Despite the contradictory views on the management of women with an ectopic arrangement of the IUD and the absence of any symptoms, all ectopic contraceptives should be removed as soon as possible after the diagnosis, taking into account the type and localization of the IUD.

Preventing Error in the Operating Room: Five Teaching Strategies for High-Stakes Learning

BackgroundEffective communication in the operating room between the attending and resident surgeon is necessary to prevent surgical errors. Yet, existing studies do not describe what successful intraoperative teaching looks like and how it prevents errors. Our objective was to identify strategies for successful intraoperative teaching by comparing perspectives of the learner and teacher for the same moments. Material and methodsWe conducted a naturalistic inquiry by filming five live surgical teaching cases and analyzing more than 250 teaching exchanges, centered on steps with high likelihood for error. We interviewed each attending and resident, who separately viewed cued video clips, and asked how they made their teaching more visible. We compared answers, looking for common understandings of the same moment. Answers were coded, compared to each other, refined, and combined into larger themes. ResultsWe identified five successful strategies for communicating avoidance of intraoperative errors: augmenting verbal instruction with small physical actions, pausing the surgical procedure to explain the larger picture, querying the residents’ knowledge about specific steps, creating memorable coined names, and issuing highly specific commands. Strikingly, we found a significant example of miscommunication between the attending surgeon and resident that was a near-miss uterine perforation during a dilation and curettage. ConclusionsAttending surgeons are strategic in their intraoperative communications with learners, resulting in a scarcity of surgical errors when the resident is operating. We present real examples of five successful intraoperative teaching strategies. Successful intraoperative teaching relies heavily on tacit information, necessitating that attending and resident share a common understanding about the next step of the case.

Detection of Asherman\u2019s syndrome after conservative management of placenta accreta: a case report

BackgroundWe present a case involving conservative treatment of placenta accreta, with a subsequent diagnosis of Asherman’s syndrome.Case presentationA 41-year-old Japanese woman (G2P0A2) delivered a healthy male infant via cesarean section due to preeclampsia. The placenta did not spontaneously separate and was manually removed. Adhesion was tight and placenta accreta was diagnosed. During the procedure, no uterine inversion or perforation, and no uterine cavity adhesion, were observed. Four months postoperatively, hysteroscopy was performed. Adhesion was detected at the fundus of her uterus where the placenta had adhered to the uterus. Asherman’s syndrome was diagnosed.ConclusionsAsherman’s syndrome might occur after conservative management of placenta accreta, which may be a direct cause of placenta accreta recurrence. When Asherman’s syndrome is diagnosed, the site of the placenta and adhesion should be monitored during subsequent pregnancies.

Uterine rupture in pregnancy after an intervention complicated by uterine perforation: Case report and systematic review of literature

ObjectivesThe present study is a descriptive study of characteristics of women who had a uterine rupture during pregnancy with a history of uterine perforation and no previous caesarean section. Study designWe present a case report of a woman with a uterine rupture in pregnancy subsequent to a perforation made by uterine sounding and we performed a systematic review including all case-reports of uterine ruptures after perforation during dilatation and curettage or due to uterine sounding. Results14 case-reports were included in this review. 12 out of 14 women presented with abdominal pain prior to the uterine rupture. In eight out of 14 cases an abdominal ultrasound was performed and in five ultrasounds a uterine wall defect was detected, in two other cases free fluid was visible and in one case fetal bradycardia was seen. Neonatal outcome was uneventful in six cases, there where two immature fetuses born and in two cases there was fetal demise. ConclusionUterine rupture in a (supposed) unscarred uterus is a relatively unknown complication. We recommend clinicians to be aware of uterine rupture in pregnant women with abdominal pain and a history of uterine manipulation. When a uterine rupture is suspected and mother and fetus are in suspected good condition, an ultrasound examination could be an easy and fast next step.

Missing Intrauterine Device Copper-T: Case Series

An intrauterine contraceptive device (IUD) is a long acting, highly effective, economic and reversible method of contraception used worldwide. The most used devices are copper IUD (Copper-T) or Progesterone IUD. Common complications include failed insertion, pain, vasovagal reactions, infection, menstrual abnormalities, expulsion and rarely uterine embedment and perforation. In this case series we will discuss three cases of missing Copper-T. In one case Copper T was inserted at our hospital and in the other cases it was inserted in the periphery and all the cases was managed surgically with different modality. Keywords: Copper-T; Intrauterine device; laparoscopy; laparotomy; perforation.

Establishing a Low-Budget Hysteroscopy Unit in a Resource-Poor Setting

Objective: To report our experience in establishing a low-budget hysteroscopy unit in the Niger Delta Region of Nigeria over a 7-year period. Materials and Methods: A retrospective descriptive study carried out between April 1, 2010, and March 31, 2017. Transaction receipts for the hysteroscopic equipment were retrieved. Situations where we had to improvise were documented. Patients' case files were retrieved, and relevant data were extracted. Results: A cart was made by a technician; home television sets served as monitors. A back-up, handheld LED light source was used. The hysteroscopic forceps and scissors were detachable versions. Sterile urine bags were improvised for providing larger saline infusions for bipolar resections. A total of 1002 hysteroscopic procedures were performed. Majority of the patients (979 or 97.70%) presented with infertility. The most common indication for hysteroscopy was intrauterine adhesions (401 or 40.01%). While 765 (76.35%) operative hysteroscopies were performed, 237 (23.65%) were diagnostic. The most common surgical procedure performed was intrauterine adhesiolysis (483 or 63.14%). There were 4 (0.40%) cases of inadvertent uterine perforation and one case (0.10%) of glycine distension fluid overload. Conclusion: Hysteroscopy with acceptable results is possible in a resource-poor setting using numerous innovative ways to circumvent the need for some of the expensive equipment.

Missing Intrauterine Device Copper-T: Case Series

An intrauterine contraceptive device (IUD) is a long acting, highly effective, economic and reversible method of contraception used worldwide. The most used devices are copper IUD (Copper-T) or Progesterone IUD. Common complications include failed insertion, pain, vasovagal reactions, infection, menstrual abnormalities, expulsion and rarely uterine embedment and perforation. In this case series we will discuss three cases of missing Copper-T. In one case Copper T was inserted at our hospital and in the other cases it was inserted in the periphery and all the cases was managed surgically with different modality.Keywords: Copper-T; Intrauterine device; laparoscopy; laparotomy; perforation.