Introduction: Perforation of the uterus by an intrauterine device (IUD) is a rare but serious complication. We report a case of a perforated copper IUD adherent to the sigmoid colon which was successfully removed laparoscopically using a harmonic scalpel. The use of a harmonic scalpel allowed dissection of the IUD in close proximity to the serosa of the sigmoid colon with minimal risk of thermal conduction injury to the bowel.
Methods: A systematic review of the literature for the subject headings [INTRAUTERINE DEVICE], [LAPAROSCOPY] and [UTERINE PERFORATION] was conducted using Pubmed, EMBase, Cochrane Library and OCLC papersfirst. Searches were limited to human reports and English language.
Results: Uterine perforation and migration of an IUD is an uncommon, but well recognized complication of IUD contraception. The incidence of uterine perforation is estimated to occur between 0.3-1.4/1000 insertions. Currently, the most ubiquitous IUDs on the market are the Copper-7 and Copper-T IUDs and these devices account for approximately half the intestinal perforations reported in the literature. Patients with uterine perforation due to an IUD may present in many ways. Our patient presented with abdominal pain and a positive pregnancy test, however, patients may also be asymptomatic or present with stigmata of an intraabdominal IUD leading to chronic abdominal pain, omental adehesions or intestinal perforation. Due to the anatomic positioning of the sigmoid colon, it is the most common site of perforation by a perforated IUD followed by the small intestine and rectum.
Discussion:Uterine perforation by IUDs is a rare, but well recognized complication. A systematic review of the literature demonstrated that Inflammation generated by copper IUDs often times makes simple laparoscopic retrieval difficult. However, with advances in laparoscopic technique and instruments, as demonstrated by the current case, most cases of perforated IUD should be able to be managed laparoscopically.
Program Number: P170