Lippe's loop (IUD) in peritoneal cavity due to previous uterine perforation

Case contributed by Dr Craig Hacking

Presentation

Acute RIF pain, fever and rigors.

Patient Data

Age: 64
Gender: Female

The large and small bowel are within normal limits.The appendix arises from the inferior aspect of the high riding cecum and is mildly thickened with mild surrounding fat stranding. It courses laterally to the abdominal wall. No free fluid or free gas. No intra-abdominal collection.

Markedly atrophic left kidney (the patient is on haemodialysis). Simple cyst at the midpole of the right kidney. Right perinephric stranding and a region of loss of corticomedullary differentiation anteriorly.

The liver, spleen, adrenals, pancreas and gallbladder are unremarkable. Prominent retroperitoneal lymph nodes however these are not enlarged according to size criteria.

Intrauterine device (Mirena) in an anteverted fibroid uterus. In the left anterior aspect of the peritoneal cavity is a curved radiodense structure in keeping with a Lippe's loop (old version of IUD). No surrounding fat stranding. This raises the possibility of previous uterine perforation.

The lungs bases are clear. No suspicious osseous lesions.

Conclusion

  1. Right pyelonephritis. Urinalysis was positive for E.coli UTI.
  2. Mild appendiceal thickening and enlargement may reflect early appendicitis.
  3. Intra-abdominal Lippe's loop (IUD) in keeping with previous uterine perforation or erosion. The patient reports that it was inserted 30 years ago and has recently been described as lost following uteroscopy, prompting insertion of the Mirena IUD.

This radiograph was perform 2 years earlier than the CT.

Radiodense curved foreign body in the LIF has a typical configuration of a Lippe's loop, an IUD. It is not projected in the uterus suggesting migration into the peritoneal cavity. No free gas.

Case Discussion

The have been case reports of IUDs that go wandering. Tubal ligation clips often become detached and can wander though the abdomen as well.

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Case Information

rID: 36844
Case created: 13th May 2015
Last edited: 28th Sep 2016
Inclusion in quiz mode: Included

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