Uterine perforation by copper intrauterine device

Sixteen cases with uterine perforation by a copper intrauterine device (IUD) are presented. In 13 cases the IUD had been inserted within 5 months following delivery, and in 6 cases the insertion had been painful. Missing string was the first sign in most cases. Laparatomy was performed in all cases to remove the IUD. The IUD was adherent to omentum or sigmoid in 10 cases. There is an increased risk of uterine perforation if the IUD is inserted postpartum during lactation and involution of the uterus. Therefore a painful IUD insertion and a missing string demand investigation of a partial or complete perforation.     

电视腹腔镜监护宫腔镜手术128例体会

目的探讨宫腔镜手术时腹腔镜监护的临床应用价值。方法1995年3月至1999年3月宫腔镜电切术672例,128例高危病例行腹腔镜监护。结果腹腔镜检查发现有盆腔并存病变20例,术时见局部浆膜起水泡1例,子宫不全穿孔1例,术终发现子宫穿孔2例,1例切除子宫,1例腹腔镜处理。结论腹腔镜监护宫腔镜手术可及时发现子宫穿孔的先兆及子宫穿孔,并进行腹腔镜下电凝止血及缝合,但不能完全避免子宫穿孔的发生,故术终应再次腹腔镜检查盆腔。     

Retrograde cervical perforation by the copper-T device

2 cases of retrograde cervical perforation by the Copper-T of which the shaft tip protruded into the vagina are described. These perforations were in a series of 1200 insertions. 1 perforation occurred after postmenstrual insertion and the other followed postabortion insertion. Neither woman had discomfort from the perforation, which was found at routine exam. It is suggested that a routine exam be performed within the first few months after an IUD insertion.     

Small bowel perforation without tumor recurrence after radiotherapy for cervical carcinoma: report of seven cases

AIM: We describe the clinical presentation, evaluation, management and outcome of patients experiencing small bowel perforation following radiation therapy for cervical cancer. METHODS AND MATERIALS: A database consisting of 95 Japanese women with stage 0-4 A cervix cancer treated between 1991 and 2004 contained seven patients (7.4%) with small bowel perforation. RESULTS: The median age at the time of perforation was 72.5 years (range 62-78). The median time from completion of radiotherapy to perforation was 6 months (range 2-58). Surgery (one small bowel resection and anastomosis with diversion; six small bowel resection and anastomosis) was performed immediately in all seven patients. One of seven patients died of small bowel perforation (i.e. mortality rate was 14%). Bowel adhesion was detected during the operation in only three cases (43%). Signs of peritonitis were absent in six cases (86%). Severe abdominal pain was seen in all seven patients. The perforation site was ileum in all seven cases. In all patients, pathological changes were compatible with postirradiation injury of the gastrointestinal tract. CONCLUSIONS: The presenting complaints of patients with bowel perforation following radiotherapy vary, and signs of peritonitis may be absent. Emergency physicians must be alert for these complications in patients who have been treated with radiotherapy.     

Treatment of pulp floor and stripping perforation by mineral trioxide aggregate.

Mineral trioxide aggregate (MTA) has been widely used to repair various kinds of tooth perforations, but its use for obturation of the entire root canal has not been reported. We report two cases of tooth perforation successfully repaired with MTA. The first patient was a 78-year-old male with calcified canal and pulp floor perforation in the left maxillary first premolar. After bypass of the calcified palatal canal, both buccal and palatal canals were filled with gutta percha, and the pulp floor perforation was repaired with MTA. Clinical success with no evident radicular lesion was found at the 18-month follow-up. The second patient was a 51-year-old female with a stripping perforation in a C-shaped root canal of the right mandibular second molar detected after removal of a post. Following root canal debridement and calcium hydroxide therapy to control inflammation at the stripping perforation site, apical and furcation bone healing were observed by radiographic examination. The stripping perforation was repaired by obturation of the entire C-shaped root canal with MTA. Observation at the 9-month follow-up revealed bone healing without any clinical symptoms and signs. These cases suggest that MTA is an alternative root canal obturation material for treatment of stripping perforation in a C-shaped root canal and for repair of pulp floor perforation.     

Respiratory symptoms as an indicator of undiagnosed bowel perforation following laparoscopic surgery--an observation

Undiagnosed bowel perforation following diagnostic or operative laparoscopies is associated with significant morbidity and is indeed the primary cause of laparoscopy related mortality. The diagnosis of bowel perforation remains difficult, predominantly because of the highly varied clinical presentation. Respiratory symptoms have rarely been reported. We outline eight cases of undiagnosed bowel perforation in which the respiratory symptoms of dyspnoea and tachypnoea manifested themselves as an integral part of the clinical presentation. We believe these 'atypical' symptoms potentially further delayed the diagnosis and instigation of definitive management. Dyspnoea and other respiratory symptoms should be considered as additional warning signs of possible undiagnosed bowel perforation following laparoscopic surgery     

Uterine perforation following medical termination of pregnancy by vacuum aspiration

Out of 9344 first trimester elective abortions performed by vacuum aspiration, 37 uterine perforation cases occurred. The suction cannula was responsible for more than 50% of perforations. All cases were multiparous. In 56.8%, the duration of gestation was 6 weeks or less. One third of the cases had a history of child birth within the previous 6 months. Fundal and anterior wall perforations were most common. Cases with a retroverted uterus had a higher incidence of perforation (59.4%) than those with an anteverted uterus (32.4%). Exact pelvic assessment and proper technique and case management are important for preventing perforation.     

Diagnostic et prise en charge des perforations utérines par dispositif intra-utérin : à partir de 11 cas

ObjectiveIntrauterine device insertion is common. It is however not harmless and uterine perforation can be serious.Patients and methodsEleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforation and specify management.ResultsThe main symptom was pelvic pain (4 cases), pregnancy occurrence (3 cases) or unability to remove the IUD (2 cases). The intrauterine device was set during the first 9 months of post-partum in 7 cases, 2 patients were still breastfeeding. Seven patients underwent laparoscopy, 2 needed switch for laparotomy, one was treated by laparotomy only and one was lost of follow-up.Discussion and conclusionIncidence of uterine perforation after IUD insertion ranges from 0,1 to 3/1000. Pelvic pain is the most revealing symptom. Fifteen percent of perforations complicate with adjacent organ lesion. Perforation incidence seems greater if the intrauterine device is set during the 6 first weeks of post-partum and breastfeeding, but non influenced by operator practical experience. Ultrasound follow-up of patients carrying intrauterine device is controversial. Facing a suspicion of ectopic intrauterine device, pelvic ultrasound examination is the first step imaging modality and using 3D could be useful. If it fails to localize the intrauterine device, an abdominal X-ray must be performed. Ectopic intrauterine device removal is recommended.     

Perforations of uterus by intrauterine device

The article contains reports on 4 cases of perforations of the uterus by intrauterine devices (IUDs) in a 6-month period. The IUD used was a Lippes loop of 30 mm. The cases were collected from approximately 16,000 total insertions an incidence of 1 in 4000. In all 4 cases the perforation was near the right cornu. In 2 cases the patients had no symptoms for over a year after the insertion of the loop. The perforations were spontaneous and did not occur during loop insertion. The authors warn that the possibility of perforation of the uterus should be considered whenever the loop thread is not visible. They recommend laparotomy whenever such diagnosis is made. The authors conclude that perforation of the uterus is a recognized though rare hazard of the IUD, that the advantages outweigh this disadvantage, and that the idea of using paramedical medical staff in inserting the loop should be abandoned. The authors also feel that a modification of the shape of the loop would minimize the risk.     

宫腔镜电切术子宫穿孔16例分析

目的 探讨宫腔镜电切术子宫穿孔的发生原因、诊断、处理和预防方法。方法 1990年5月至2002年7月,5家医院共行宫腔镜电切术3541例次,其中宫腔镜子宫内膜切除术(TCRE)1431例,1468例次,宫腔镜子宫肌瘤切除术(TCRM)797例,宫腔镜子宫内膜息肉切除术(TCRP)783例,宫腔镜子宫纵隔切除术(TCRS)189例,宫腔镜子宫粘连切除术(TCRA)112例,宫腔镜宫腔异物取出术(TCRF)192例。术时均行B超和(或)腹腔镜监护,手术日前晚放置宫颈扩张棒或于阴道后穹窿放置米索前列醇200μg,手术步骤按不同的指征及目的进行。结果 发生子宫穿孔16例(0．45％),8例因放置器械所致,其中7例扩宫时穿孔,1例置镜时穿孔,8例为电切电极引起。子宫穿孔发生率,TCRA 4．46％(5／112),TCRF 3．12％(6／192),TCRE 0．27％(4／1468),TCRM 0．13％(1／797);TCRP及TCRS无子宫穿孔发生。16例穿孔均于术中发现,其中B超和(或)腹腔镜监护发现10例(62％),宫腔镜及临床发现6例(38％)。13例为完全子宫穿孔,其中腹腔镜监护发现2例,B超监护发现5例,宫腔镜先于B超发现4例,患者首先出现症状,然后B超证实子宫穿孔2例;子宫不全穿孔3例,2例腹腔镜监护发现,1例B超监护发现。结论 应尽量减少扩宫,置镜在直视下进行;术者的经验及手术类型如TCRA和TCRF与子宫穿孔的发生有关。宫腔镜电切术时B超、腹腔镜监护有助于预防,但不能完全防止子宫穿孔。     

About two cases of uterine rupture outside of labour: consequences of an unnoticed previous perforation

The uterine mute perforation following uterine evacuation of pregnancy exists; the obstetrical consequences of these are quite unknown. We report 2 cases of pregnancy complicated by uterine rupture and defect after uterine mute perforation. The physical signs are late and misleading. The notion of perforation during the instrumental evacuation of pregnancy must be mentioned for an adequate follow-up. Management thus remains essentially preventive.     

Spontaneous uterine perforation of pyometra. A report of three cases

BACKGROUND: Spontaneous perforation of pyometra is a rare cause of generalized peritonitis; only 17 cases have been reported. CASES: Three cases of spontaneous perforation of pyometra occurred; two were associated with carcinoma of the cervix. All were treated with exploratory laparotomy and drainage. The first patient died of recurrent carcinoma of the cervix five months after laparotomy. The second patient died of septic shock shortly after the operation. The third patient made a good postoperative recovery. CONCLUSION: Pyometra is a serious medical condition, because of both its association with malignant disease and the danger of spontaneous perforation, which carries significant morbidity and mortality. Although rare, ruptured pyometra should be considered in the differential diagnosis of acute abdomen in elderly women, especially those with malignant disorders of the genital tract. The treatment of pyometra rupture is immediate laparotomy, peritoneal lavage and drainage, or simple hysterectomy.     

The “catheter bag” sign revisited: a simple way detecting bladder trauma during operative laparoscopic procedures

Early detection and repair of bladder perforation reduce postoperative morbidity. We describe two cases of bladder perforation sustained during complicated laparoscopic adhesiolysis and discuss a previously reported simple method of detecting bladder trauma during operative laparoscopy.     

Laparoscopy as a diagnostic and therapeutic technique in uterine perforations during first-trimester abortions

During the period 10/71 to 1/73, laparoscopy was performed in 11 cases of instrumental uterine perforation during 1st trimester abortion at the New York Hospital-Cornell Medical Center. 7 of the 11 patients did not require laparotomy; the remaining 4 had laparotomy after preliminary laparoscopy (3 had uncontrollable bleeding or extensive uterine injury while 1 had bowel injury due to the laparoscope trocar). The reported incidence of uterine perforations during 1st trimester abortion ranges from 0.4/1000 abortions to 15/1000 abortions. The incidence is lowest when the abortion is performed using suction technique and local anesthesia. In this hospital, laparoscopy is performed as soon as the perforation occurs, using the same anesthesia if general anesthesia was used. Immediate laparotomy is performed in cases of extensive instrumentation after perforation or bowel injury. Abortion is completed either by suction or sharp curette; intra-abdominal bleeding can be controlled by cauterization under laparoscopic observation. This procedure eliminates the need for patient exploratory laparotomy and hence shortens hospital stay and minimizes medicolegal problems. The management of uterine perforation during 1st trimester abortion is also discussed.     

Placenta accreta and percreta: a review of 5 cases

Five cases of placenta accreta and percreta are reviewed. Three cases, one a recurrence in the same patient, presented with acute abdominal pain; in one case perforation resulting from placenta percreta was discovered at laparotomy. In another case, placenta accreta was recognized during cesarean delivery. Total or subtotal hysterectomy was performed in three cases; piecemeal removal of placental tissue and closure of the tear was performed in two of the patients. There were no maternal deaths, but the infants were stillborn in three cases of perforation or uterine rupture.     

Perforation of the uterus by copper-IUDs.

In about 5 000 copper-IUD insertions 5 cases of perforation were found. One woman had 2 devices inserted, both of them perforated. Copper-T was responsible for 3 corporal perforations and copper-7 for 2 corporal and 1 cervical perforation.     

Non-obstructive cecal dilatation and perforation after cesarean section

A case of non-obstructive cecal dilatation and perforation after cesarean section is reported, with a review of the literature on the diagnosis and management of this entity. Fifteen cases have been described. Attention is called to this rare complication and to the accompanying pseudo-obstructive syndrome, the diagnosis of which is important in order to avoid cecal perforation. Non-obstructive cecal dilatation is a life threatening complication to cesarean section, and immediate surgical intervention is important.     

Large bowel perforation by intrauterine contraceptive devices.

Two cases of large bowel perforation by intrauterine contraceptive devices are presented. Both the Lippes LoopTM and Dalkon ShieldTM have the potential of evoking omental adhesions and causing bowel perforation. These serious complications justify the immediate removal of a contraceptive device from the peritoneal cavity by either laparoscopy or laparatomy.     

Spontaneous Intestinal Perforation in Pregnancy from a Pre-Existing Postoperative Adhesion: A Case Report

BackgroundSpontaneous intestinal perforation is rare in pregnancy. Previously described cases have been associated with endometriosis, Crohn's disease, and intestinal tuberculosis.CaseWe describe a case of spontaneous intestinal perforation in pregnancy from a postoperative adhesion. The patient presented with multiple episodes of abdominal pain and vomiting starting at 25⁵ weeks. The diagnosis was made at 28 weeks when she presented with severe pain and abnormal fetal heart rate requiring emergency cesarean section with bowel resection.ConclusionThis case demonstrates that adhesions between the bowel and uterus from prior surgery may lead to spontaneous intestinal perforation as the uterus enlarges during pregnancy. As this diagnosis can be difficult because of imaging limitations and physiologic changes of pregnancy, it should be considered in cases of unremitting abdominal pain and vomiting.     

Uterine Perforation Associated with Endometrial Ablation

Three cases of uterine perforation associated with endometrial ablation are presented. Possible predisposing factors in 2 cases were previous Caesarean section and difficulty in cervical dilatation. Adequate training for gynaecologists in hysteroscopy is essential before undertaking any type of operative hysteroscopy.