IUCD-related uterine perforation

Last revised by Joshua Yap ◉ on 27 Feb 2023

Citation, DOI, disclosures and article data

Citation:

Harvey H, Yap J, Baba Y, et al. IUCD-related uterine perforation. Reference article, Radiopaedia.org (Accessed on 27 Sep 2023) https://doi.org/10.53347/rID-14999

DOI:

https://doi.org/10.53347/rID-14999

Permalink:

https://radiopaedia.org/articles/14999?iframe=true

rID:

14999

Article created:

12 Sep 2011, Hugh Harvey

Disclosures:

At the time the article was created Hugh Harvey had no recorded disclosures.

View Hugh Harvey's current disclosures

Last revised:

27 Feb 2023, Joshua Yap ◉

Disclosures:

At the time the article was last revised Joshua Yap had no financial relationships to ineligible companies to disclose.

View Joshua Yap's current disclosures

Revisions:

45 times, by 19 contributors - see full revision history and disclosures

Systems:

Obstetrics, Gynaecology

Tags:

cases, ultrasound, abr certifying ultrasound, gynecology

Synonyms:

Perforation of the uterus due to an IUCD
IUCD perforation
Perforation of the uterus due to an IUD
IUD perforation
Intrauterine contraceptive device related perforation
Intrauterine device related perforation
Intrauterine contraceptive device migration

IUCD-related uterine perforations are one of the causes of uterine perforation. It is a rare, but serious complication of an intrauterine contraceptive device (IUCD), and is often clinically silent.

Perforation of the uterus at the time of insertion may be clinically 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.

Pathology

IUCD-related uterine perforation ranges from embedment in the myometrium to complete transuterine perforation with a migration of the intrauterine contraceptive device into the peritoneal cavity ⁶.

Embedment refers to the penetration of an intrauterine contraceptive device into the endometrium or myometrium without extending through the serosa.

Intra-abdominal migration occurs when the intrauterine contraceptive device is freely floating in the abdomen or pelvis encased in adhesions or adherent to bowel or the omentum. Adhesions can lead to infertility, chronic pain, and intestinal obstruction ⁶.

Etiology

Uterine perforation is thought to be related to low estrogen levels leading to uterine shrinkage.

Radiographic features

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