Ovarian embedding of a transmigrated intrauterine device: a case report and literature review

Aim  To report an unusual location of a transmigrated IUD which become embedded in the right ovary causing chronic pelvic pain and dyspareunia. Case  A 22-year-old woman who had an IUD (Copper T), inserted 7 years ago presented with complaint of lower abdominal pain. Pelvic ultrasonographic examination revealed ovarian embedding of the IUD. Laparoscopic IUD removal was successfully performed. Discussion  De novo lower abdominal pain in a woman with an IUD in situ should alert the clinician to the possibility of total or partial transmigration of the device into the pelvis or abdomen. Ovarian penetration is very rare and this is the second case of IUD transmigration into the ovary reported in the medical literature.     

A case of unruptured intrafollicular ovarian pregnancy diagnosed prior to operation

A case of an unruptured intrafollicular ovarian pregnancy of 8 gestational weeks diagnosed by ultrasonography in a virtually asymptomatic patient is reported. A 32 year-old woman with 1 vaginal delivery 8 years ago presented with a history of intermittent spotting after removal of an IUD during her last menstrual period 4 weeks ago. IUD was inserted 6 years prior. The patient was symptom-free and showed no abnormal findings upon vaginal examination. Transvaginal ultrasonography however disclosed a gestational sac with a live embryo within the left ovary. The woman was operated on via laparotomy without delay. The intraoperative finding showed a normally appearing corpus luteum in the intact left ovary without any visible abnormality of the pelvic organs. Having in mind the US finding a resection of the corpus luteum was done revealing the gestational sac within it. The authors describe the following three US signs specific of unruptured intrafollicular ovarian pregnancy: extremely thickened uniformly echogenic wall of the sac, the sac is partially surrounded by ovarian structure, no corpus luteum is detected in either ovary. The essential role of transvaginal ultrasonography in the precise diagnosis of the ectopic pregnancy and its location is emphasized. The absence of specific complaints and findings until rupture of the ovary occurs and the association of ovarian pregnancy and IUD are also confirmed by the case-report.     

Ovarian and vesical actinomycosis: a case report and literature review

We present a patient with a tubo-ovarian abscess pathologically confirmed to be actinomycosis in a 44-year-old woman with an intrauterine device (IUD). An ultrasound showed that the IUD was imposed on an apparently degenerated myoma. A pelvic MRI was performed to differentiate the uterine findings from a sarcoma. The MRI showed a heterogeneous pelvic mass and a bladder mass suggesting chronic inflammation caused by an organism such as actinomycosis. An exploratory laparotomy was performed, which revealed a right tubo-ovarian mass with abscess formation as well as a bladder mass. A subtotal hysterectomy, right salpingoophorectomy, partial cystectomy, and appendectomy were performed in addition to drainage of the abscess. Histopathological examination revealed a tubo-ovarian abscess and a bladder mass with colonies of actinomycoses.     

A case of tubal pregnancy caused by an intrauterine contraceptive device]

A young patient, a wearer of a copper IUD for about 18 months, was hospitalized for bleeding and severe pain. Several tests were performed and a diagnosis of tubal pregnancy made. The patient underwent surgery for rupture of the left oviduct. Presence of corpus luteum was found in the right ovary. It is possible that the presence of the copper IUD helped in the formation of substances similar to prostaglandins, which caused peristaltic contractions in the left oviduct.     

Pelvic actinomycosis: a case report

BACKGROUND: Pelvic actinomycosis is rare but can manifest with multiple presentations. CASE: A 28-year-old woman, gravida 4, para 2, conceived with a Paraguard intrauterine device (IUD) (FEI Products LLC, North Tonawanda, New York) in place. The IUD had been present for 2 years. The patient presented with an incomplete abortion at 6 weeks' gestation, and the IUD was removed. Two and one-half months later the patient presented with signs and symptoms of pelvic inflammatory disease and underwent hospitalization and exploratory laparotomy. The pathology specimen revealed diffuse actinomycosis involving the tube and ovary, appendix, and bowel mucosa. A Pap smear 3 months earlier had revealed Actinomyces. CONCLUSION: Actinomyces has been associated with IUD use and may present even after removal of the IUD. Pelvic actinomycosis is rare, and removal of the IUD may not be adequate treatment. If a patient presents with symptoms of infection, early diagnosis and aggressive antibiotics may prevent further complications.     

IUD appendicitis

A case of uterine perforation by an IUD with acute and chronic irritation of the appendix is presented. The patient, a 30-year old gravida 4, para 4, was admitted to the hospital with severe abdominal pain, fever, and diarrhea. A Lippes loop IUD had been inserted 3 years previously. The device could not be visualized at laparoscopy. At laparotomy the IUD was palpable within a large inflammatory mass in the right lower abdomen . Dissection of the adhesions revealed the IUD twisted around the appendix, and appendectomy was performed. This is the 1st reported case of a perforated, nonmedicated IUD causing appendicitis. The 2 cases of IUD appendicitis previously described in the literature involved Copper-7 devices, which have been shown to cause considerable tissue response when placed in the peritoneal cavity. Abdominal signs and symptoms associated with a missing IUD string should alert physicians to the possibility of IUD appendicitis.     

Symptomatic large bowel endometriosis in a woman with a hormonal intrauterine device: a case report

BACKGROUND: Extragenital endometriosis can occur in the rectum and sigmoid causing cyclic rectal bleeding. A hormonal intrauterine device (IUD) (20 microg/24 h levonorgestrel releasing), originally developed as an easily reversible contraceptive method, is a therapeutic option for bleeding disorders. CASE: A 34-year-old woman using depot progesterone injection (crys-talline suspension of 150 mg medroxyprogesterone acetate) for contraception was amenorrheic and asymptomatic. After switching to a levonorgestrel-releasing IUD the patient experienced irregular bleeding with concomitant dysmenorrhea and rectal bleeding. Colonoscopy revealed a sigmoid mass. Laparotomy with resection of the sigmoidal mass and ovarian cyst was performed. Histopathologic analysis confirmed the suspected diagnosis of large bowel endometriosis. CONCLUSION: In our patient, large bowel endometriosis became symptomatic 2 years after insertion of hormonal IUD. The suppressive effect of the hormonal IUD seemed to be insufficient for the control of extragenital endometriosis.     

IUD-associated ovarian actinomycosis causing bowel obstruction

This case report presents an unusual case of primary IUD-associated ovarian actinomycosis, which spread to the sigmoid causing intestinal obstruction. A 43-year-old gravida 3, para 2, had her 1st IUD from 1978-80 (Gyne-T) and her 2nd IUD from 1980 to October 1983 (Multiload). Right lower abdominal pain led to hospitalization in May 1983. A tender nodular mass was palpated in the left pelvic area. Laboratory results confirmed the presence of inflammation. Rapid improvement followed a course of laxatives and cephalosporin antibiotics, and the patient was discharged with the diagnosis of acute sigmoid diverticulitis. 2 months later, a double contrast examination of the large intestine was done and showed severe narrowing of the sigmoid colon over a distance of 12 cm and occasional sharp recesses. Colonoscopy showed a spastic stricture of the sigmoid with massive edema of the otherwise intact mucosa at 18 cm. Computer tomography of the abdomen showed a large, focally cystic infiltrative mass in the pelvis with congestion and displacement of both ureters as well as bilateral hydronephrosis, predominantly on the right side. The descending colon was congested. The patient was readmitted to hospital with the tentative diagnosis of ovarian cancer when her general condition deteriorated. She complained again of abdominal pain in the right lower quadrant and alternating diarrhea and constipation. Pyrexia and the hematological findings suggested sepsis. The pelvis contained a predominantly leftsided nodular mass and a brown fetid discharge was coming through the cervix. The IUD was removed and treatment with ampicillin and clindamycin was started with rapid improvement in the patient's condition. Obstruction with extreme distention of the colon required emergency laparotomy. An inflammatory mass was found in the pelvis consisting of a right-sided ovarian tumor, bilateral hydrosalpinges, and a tightly encased sigmoid colon. The dilated caecum had a large necrotic area in its wall which necessitated caecostomy and double-current sigmoidostomy after subtotal hysterectomy and bilateral salpingo-oophorectomy. The patient made a good recovery. As recently as the 1950s, primary pelvic actinomycosis was a rarity. In the last 4 years alone, 20% of all reported cases of actinomycosis involved the female genital tract. The percentage of cases found among IUD users has been continuously increasing and in the last 2 years all published cases were IUD users. The presence of actinomyces in vaginal smears always is indicative of the presence of a foreign body, most commonly and IUD.     

Rates of Intrauterine Device Expulsion Among Adolescents and Young Women

Study ObjectiveThe objective of our study was to determine the rate of intrauterine device (IUD) expulsion and risk factors for expulsion among adolescents and young adults.DesignRetrospective chart review.SettingIUD insertions were performed at a single children's hospital.ParticipantsEligible adolescent and young adult patients who underwent IUD insertion between August 2009 and March 2019.InterventionsIUD insertion.Main Outcome MeasuresPrimary outcome was the incidence of IUD expulsion in adolescents and young women. Secondary outcomes were risk factors for IUD expulsion including heavy menstrual bleeding, abnormal uterine bleeding (AUB), anemia, or a bleeding disorder diagnosis.ResultsSix hundred forty-two eligible patients underwent IUD insertion. The incidence of first IUD expulsion in this population was 58/642 (9.03%). Among those who chose to have a second IUD placed (n = 29), 8/29 (27.6%) had a second expulsion. Patients who expelled their IUD were more likely to have a history of AUB, heavy menstrual bleeding, anemia, or a bleeding disorder. When controlled for body mass index and age at insertion, history of AUB and anemia remained significant risks for IUD expulsion.ConclusionThis study similarly showed a higher risk of primary and secondary IUD expulsion in adolescents and young women. A history of AUB, anemia, bleeding disorder, and elevated body mass index are associated with higher risk for IUD expulsion. This population should be counseled that these conditions might place them at higher risk for expulsion.     

Pelvic abscess in intrauterine device users.

OBJECTIVE: To assess the causality between pelvic abscess formation and intrauterine device (IUD) use through a clinical study in a hospital. METHOD: Sixty-two pelvic abscesses were retrospectively evaluated over a 7-year period. Patient records retrieved for the women enrolled in this study consisted of demographic characteristics, duration of IUD use and clinical management details. RESULTS: All the women were monogamous Muslim women without any suspicious sexual contacts, immunosupressive states, or drug use at the time of IUD insertion. In 10 cases (16.1%), a history of pelvic surgery was present. The mean age of the women was 36.1 +/- 2.3 years (range 19-50 years). Of the 62 women, 14 (22.6%) were current IUD users. The mean time interval for women using IUD prior to the diagnosis of pelvic abscess was 5.7 +/- 1.2 years (range 1-14 years). In all cases, a pelvic mass and abdominal pain constituted the referral signs and symptoms. All women received an initial antibiotic regimen comprising penicillin (24 mU/day), clindamycin (900 mg/day) and gentamycin (240 mg/day) in divided doses. In 38 cases (61.3%), medical treatment yielded a satisfactory clinical outcome, defined as a decreas in mass volume together with pain relief and a decrease in leukocytosis. Twenty-four cases (38.7%) underwent a subsequent surgical procedure, either laparotomy (n = 19) or laparoscopy (n = 5). The type of surgery ranged from abscess drainage to more radical approaches such as total abdominal hysterectomy and/or unilateral or bilateral salpingo-oophorectomy. There were no differences between those women responding to medical therapy and those who did not respond in terms of mean age, percentage of past pelvic surgery, gravidity, parity and the size of pelvic abscess. CONCLUSIONS: A substantial number of women with an IUD were diagnosed as having a pelvic abscess within a 7-year period at the university clinic. Despite current knowledge that pelvic inflammatory disease and pelvic abscess are rarely encountered in long-term IUD users, the presence of an IUD should be investigated in cases with an initial diagnosis of pelvic abscess based on clinical and ultrasonographic evaluation, demonstrating mostly acquisition via sexually transmitted disease.     

Pelvic actinomycosis with retained intrauterine fetal bone: a case report

BACKGROUND: Pelvic actinomycosis is a rare infection that can manifest as pelvic inflammatory disease and in severe cases can cause extensive fibrosis. Most cases are associated with long-standing use of an intrauterine device (IUD). CASE: A 30-year-old woman presented with abdominal pain, fever and a pelvic mass. She underwent removal of an intrauterine foreign body, surgical drainage of a tuboovarian abscess and intravenous antibiotic therapy. Pathology studies revealed that the foreign body consisted of bone tissue, and the agent of infection was identified as Actinomyces israelii. CONCLUSION: Pelvic actinomycosis, although usually occurring in women using an IUD, may result from retained intrauterine fetal bone through a similar pathogenesis.     

Hematoma de mama que simula un cáncer y cáncer de mama que debuta con hematoma

Some benign breast lesions, such as hematoma, may present mammographically as a speculated or ill-defined mass mimicking a carcinoma. Equally, an unknown malignant lesion can bleed and appear clinically as a breast hematoma. We report the cases of two patients: the first patient had a mammographic lesion suggestive of carcinoma that was later revealed to be a breast hematoma. The second patient, who was receiving anticoagulant therapy, had a breast hematoma that required surgical drainage. Surgery revealed an apparently malignant underlying lesion. The malignancy was confirmed by histological analysis.     

Tubo-ovarian abscess formation in users of intrauterine devices remote from insertion: a report of three cases

Background: The association between tubo-ovarian abscess formation and the presence of an intrauterine device (IUD) is well recognized. It has been suggested that the risk of upper-genital-tract infection is highest during the immediate period following the insertion of an IUD, returning to baseline by 5 months postinsertion. We present 3 cases of women who, 10-21 years after insertion of their IUDs, developed tubo-ovarian abscesses that were not causally related to sexually transmitted diseases (STDs) or actinomycetes.Cases: Three women, ages 39-47 years, presented to our gynecology service for evaluation of abdominal pain. One woman had bilateral tubo-ovarian abscesses and the other 2 had unilateral tubo-ovarian abscesses. All 3 were IUD users, with an interval from IUD insertion to presentation of 10-21 years. In each case, the cervical cultures for gonorrhea and chlamydia were negative at presentation and the sexual history was not consistent with an STD mode of spread. All 3 women initially received broad-spectrum antibiotics, but 2 eventually required definitive surgical therapy.Conclusion: Long-term users of IUDs remain at risk for serious, indolent pelvic infections. These women should be counseled by their gynecologists on an ongoing basis as to this persistent risk. Tubo-ovarian abscess should be strongly considered in the differential diagnosis of an IUD user who presents with an adnexal mass, fever, or abdominal pain.     

Pathogenesis of acute pelvic inflammatory disease: role of contraception and other risk factors.

In a case-control study of matched pairs, the risk of acute pelvic inflammatory disease (PID) was 4.4 times higher in intrauterine contraceptive device (IUD) users than in nonusers (p less than 0.001). Of approximately 500,000 cases of acute PID occurring annually in the United States, an estimated 110,000 are attributable to IUD's, costing over forty-four million dollars per year. PID was attributable to the IUD in 77 per cent of IUD users. No particular type of IUD was implicated. The relative risk of acute PID in IUD users over nonusers was higher in nulligravid women than in previously pregnant women and was directly related to socioeconomic status (SES), but the total annual risk of PID in IUD users appear inversely related to SES. IUD use significantly increased the risk of nongonococcal PID. Fever occurred in 13 (21 per cent) of 61 IUD users and 59 (41 per cent) of 143 nonusers (p less than 0.025). Among women with nongonococcal PID, and adnexal mass greater than or equal to 6 cm. was noted in 14 (40 per cent) of 35 IUD users and in only 12 (15 per cent) of 78 nonusers (p less than 0.01). An increased risk of gonococcal PID was found among non-Caucasians and women not using contraception, while the risk of nongonococcal PID was increased among women with a past history of gonorrhea. Oral contraceptive use may protect women with gonorrhea from developing PID. Menstruation precipitates the onset of symptoms of gonococcal PID.     

Pelvic abscess in intrauterine device users

Objective?To assess the causality between pelvic abscess formation and intrauterine device (IUD) use through a clinical study in a hospital.

Method?Sixty-two pelvic abscesses were retrospectively evaluated over a 7-year period. Patient records retrieved for the women enrolled in this study consisted of demographic characteristics, duration of IUD use and clinical management details.

Results?All the women were monogamous Muslim women without any suspicious sexual contacts, immunosupressive states, or drug use at the time of IUD insertion. In 10 cases (16.1%), a history of pelvic surgery was present. The mean age of the women was 36.1?±?2.3 years (range 19–50 years). Of the 62 women, 14 (22.6%) were current IUD users. The mean time interval for women using IUD prior to the diagnosis of pelvic abscess was 5.7?±?1.2 years (range 1–14 years). In all cases, a pelvic mass and abdominal pain constituted the referral signs and symptoms. All women received an initial antibiotic regimen comprising penicillin (24?mU/day), clindamycin (900?mg/day) and gentamycin (240?mg/day) in divided doses. In 38 cases (61.3%), medical treatment yielded a satisfactory clinical outcome, defined as a decreas in mass volume together with pain relief and a decrease in leukocytosis. Twenty-four cases (38.7%) underwent a subsequent surgical procedure, either laparotomy (n?=?19) or laparoscopy (n?=?5). The type of surgery ranged from abscess drainage to more radical approaches such as total abdominal hysterectomy and/or unilateral or bilateral salpingo-oophorectomy. There were no differences between those women responding to medical therapy and those who did not respond in terms of mean age, percentage of past pelvic surgery, gravidity, parity and the size of pelvic abscess.

Conclusions?A substantial number of women with an IUD were diagnosed as having a pelvic abscess within a 7-year period at the university clinic. Despite current knowledge that pelvic inflammatory disease and pelvic abscess are rarely encountered in long-term IUD users, the presence of an IUD should be investigated in cases with an initial diagnosis of pelvic abscess based on clinical and ultrasonographic evaluation, demonstrating mostly acquisition via sexually transmitted disease.     

Removal of intra-abdominal intrauterine device by laparoscopy.

OBJECTIVE: In this study, we aimed to evaluate the cases in which intra-abdominal intrauterine devices (IUDs) were removed by laparoscopy. METHODS: A retrospective study, from 1994 to 2000 was carried out with eight patients who underwent laparoscopy for the removal of an IUD. The patients admitted to our clinic with 'lost IUD' were examined by pelvic ultrasonography, X-ray and hysteroscopy. IUDs were found to be extrauterine but within the abdominal cavity. The IUDs were removed by operative laparoscopy. RESULTS: The mean age of the patients was 31.5 years. The mean duration of usage of IUD was 5.5 years. The IUD was located in the cavity of Douglas in four cases, in the posterior wall of the uterus (perimetrium) in one case and in the conglomerated mass bordered by the intestines in three cases. The types of the IUDs were Cu-T 380A (n = 5), Multiload (n = 1) and Lippes-Loop (n = 2). The mean laparoscopic operation time was 25 min. No major complications (intestinal or vessel injuries) or minor problems occurred. Laparotomy was not necessary in any of the eight cases. All cases were treated as out-patients and discharged on the same day. After counselling, three women requested sterilization, which was performed at the same laparoscopy session by the administration of bilateral Yoon rings, and other family planning methods were chosen by five women. There were no problems when cases were followed at the 10th and 30th postoperative days. DISCUSSION: Our results support the idea that, in cases of extrauterine but intra-abdominal IUD, laparoscopic removal of the IUD must be the first choice of therapy.     

Contraception and cervical colonization with mycoplasmas and infection with cytomegalovirus.

The relationship of cervical colonization of genital mycoplasmas and infection with cytomegalovirus (CMV) was studied in 66 intrauterine device (IUD) users as contrasted to 60 patients using oral contraception and 50 patients using neither an IUD nor oral contraception. No significant increase in colonization or genital mycoplasmas or infection with CMV was noted in IUD users. No CMV was isolated from users of the cooper-t IUD. It is unlikely that genital mycoplasmas are related to either the increased immunoglobulin levels seen in patients using the IUD or the antifertility effects of the IUD.     

IUD removal with colonoscopy: a case report

BACKGROUND: Intrauterine device (IUD) perforation of the bowel is uncommon. Although IUD perforation may be asymptomatic, the most common complaint is unexplained abdominal pain. CASE: A case of IUD perforation of the large bowel was diagnosed 7 years after insertion. The patient presented with unexplained lower abdominal pain diagnosed initially as pelvic inflammatory disease. Laparoscopy revealed that the IUD was embedded deeply in the rectum. Bowel preparation and intravenous antibiotics followed by colonoscopy using a grasping snare resulted in successful IUD removal. CONCLUSION: Patients presenting with IUDs embedded in the large bowel may benefit from attempted removal using colonoscopy rather than laparotomy. Bowel preparation, intravenous antibiotics and pos-textraction evaluation to rule out perforation may be prudent.     

吲哚美辛宫内节育器的主要药效学研究

本文应用放射免疫法测定吲哚美辛 IUD对离体大鼠子宫匀浆中前列腺素类物质(PGs)释放的影响 ,用光镜和电镜观察放置吲哚美辛 IUD后大鼠子宫内膜的形态学变化 ,并测定吲哚美辛 IUD在大鼠子宫内的动态释放规律。结果表明 :吲哚美辛组 PGs释放约为铜组的 1 / 5～ 1 / 1 0 (P<0 .0 5 ) ,而且吲哚美辛抑制 PGs释放的作用随药物浓度增加而增强。铜组和硅橡胶组 PGs释放均有随时间累积而增加趋势 ,而吲哚美辛组无此表现。 6KF和 TXB2 的比值 ,吲哚美辛组和硅橡胶组均 <1 (0 .6～ 0 .8) ,而铜组则均 >1 (1 .3～ 2 .1 )。组织学观察 ,铜 IUD组可见子宫内膜组织充血水肿 ,微血管以扩张为主 ,吲哚美辛 IUD组则无充血水肿表现 ,微血管以正常和收缩状态为主。吲哚美辛 IUD在大鼠子宫内药物释放量 3 d后稳定 ,释放速度稳定递减 ,符合均质型缓释规律。