IUCD-related uterine perforation

Changed by Aditya Shetty, 15 Sep 2015
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IUCD related uterine perforations are one of the causes of uterine perforation. It is a 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

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.

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 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>
  • +<p><strong>IUCD related uterine perforations</strong> are one of the causes of <a href="/articles/uterine-perforation">uterine perforation</a>. It is rare, but a 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>
  • -</ul><h4>Radiographic features</h4><p>Ultrasound is the recommended first line investigation <sup>3</sup> 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.</p><h5>Ultrasound</h5><ul>
  • +</ul><h4>Radiographic features</h4><p>Ultrasound is the recommended first line investigation <sup>3</sup> 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.</p><h5>Ultrasound</h5><ul>

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