IUCD-related uterine perforation
Updates to Article Attributes
IUCD related uterine perforations are one of the causes of uterine perforation. It is a rare, but serious complication of an IUCD insertion, and is often clinically silent1
Epidemiology
The incidence rate is reported between 1.6 and 2.2at ~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 non-specificnonspecific lower abdominal pain. In all cases the visible 'strings' will be missing at direct inspection. Peritoneal sepsis is a rare presentation.
Pathology
AssocationsAssociations
- atrophic /
post-partumpostpartum 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 second line. CT can be used in complex cases where visceral involvement or surgical difficulty is suspected.
Ultrasound
- may have a normal endometrial cavity on ultrasound
- hyperechoic linear structure lying outside the uterus
Conventional radiography
- an IUCD lying lateral to midline may suggest the diagnosis
Treatment and prognosis
Treatment depends on the degree of perforation and whether there are any complications (such as peritoneal sepsis or intestinal obstruction).
-<p><strong>IUCD related uterine perforations</strong> are one of the causes of <a href="/articles/uterine-perforation">uterine perforation</a>. It is a rare, but serious complication of an <a href="/articles/intra-uterine-contraceptive-device-1">IUCD</a> insertion, and is often silent <sup>1</sup>. </p><h4>Epidemiology</h4><p>The incidence rate is reported between 1.6 and 2.2 in 1000 <sup>2</sup>.</p><h4>Clinical presentation</h4><p>Perforation at the time of insertion may be silent, or cause significant pelvic pain. A late perforation may be asymptomatic, or present with non-specific lower abdominal pain. In all cases the visible 'strings' will be missing at direct inspection. Peritoneal sepsis is a rare presentation.</p><h4>Pathology</h4><h5>Assocations</h5><ul>-<li>atrophic / post-partum uterus</li>- +<p><strong>IUCD related uterine perforations</strong> are one of the causes of <a href="/articles/uterine-perforation">uterine perforation</a>. It is a rare, but serious complication of an <a href="/articles/intra-uterine-contraceptive-device-1">IUCD</a> insertion, and is often clinically silent. </p><h4>Epidemiology</h4><p>The incidence rate is reported at ~2 in 1000 <sup>2</sup>.</p><h4>Clinical presentation</h4><p>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.</p><h4>Pathology</h4><h5>Associations</h5><ul>
- +<li>atrophic / postpartum uterus</li>
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Image 6 X-ray (Frontal) ( create )
