IUCD-related uterine perforation

Changed by Yuranga Weerakkody, 11 Jul 2018
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IUCD related uterine perforations are one of the causes of uterine perforation. It is rare, but a serious complication of an IUCD insertion, and is often clinically silent. 

Epidemiology

The incidence rate is reported at ~2 in 1000 2.

Clinical presentation

Perforation at the time of insertion may be clinically silent, or cause significant pelvic pain. A late perforation may be asymptomatic, or present with nonspecific lower abdominal pain. In all cases, the visible 'strings' will be missing at direct inspection. Peritoneal sepsis is a rare presentation.

Pathology

IUD perforation ranges from embedment in the myometrium to complete transuterine perforation with migration of the IUD into the peritoneal cavity.6

Embedment refers to penetration of IUD into the endometrium or myometrium without extension through the serosa.

Intraabdominal migration occurs when the IUD is freely floating in the abdomen or pelvis encased in adhesions or adherent to bowel or omentum. Adhesions can lead to infertility, chronic pain, and intestinal obstruction.6

Associations
  • atrophic / postpartum uterus
  • uterine structural abnormalities 5
  • large fibroids 5

Radiographic features

Ultrasound is the recommended first line investigation 3 in all women in whom the ‘strings’ cannot be visualised. Orthogonal radiographs are often the second line. CT can be used in complex cases where visceral involvement or surgical difficulty is suspected.

Plain radiograph
  • an IUCD lying lateral to midline may suggest the diagnosis
Ultrasound
  • may have a normal endometrial cavity on ultrasound
  • hyperechoic linear structure lying outside the uterus

Treatment and prognosis

Treatment depends on the degree of perforation and whether there are any complications (such as peritoneal sepsis or intestinal obstruction).

See also

  • -</ul><h4>Treatment and prognosis</h4><p>Treatment depends on the degree of perforation and whether there are any complications (such as peritoneal sepsis or intestinal obstruction).</p><h4>See also</h4><p><a href="/articles/embedded-intrauterine-contraceptive-device">Embedded intrauterine contraceptive device</a></p>
  • +</ul><h4>Treatment and prognosis</h4><p>Treatment depends on the degree of perforation and whether there are any complications (such as peritoneal sepsis or intestinal obstruction).</p><h4>See also</h4><ul><li><a href="/articles/embedded-intrauterine-contraceptive-device">embedded intrauterine contraceptive device</a></li></ul>

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