|Year : 1989 | Volume
| Issue : 2 | Page : 116-7
Laparoscopic retrieval of transmigrated IUDS (report of 3 cases).
AM Virkud, SK Shah
A M Virkud
Source of Support: None, Conflict of Interest: None
Three cases in whom transmigrated IUDs were removed with operative laparoscope are presented.
Keywords: Adult, Female, Foreign Bodies, surgery,Human, Intrauterine Devices, adverse effects,Intrauterine Devices, Copper, adverse effects,Laparoscopy, Peritoneal Cavity, Uterine Perforation, etiology,Uterine Rupture, etiology,
|How to cite this article:|
Virkud A M, Shah S K. Laparoscopic retrieval of transmigrated IUDS (report of 3 cases). J Postgrad Med 1989;35:116
| :: Introduction|| |
Laparoscopy has been used for the diagnosis of perforated or transmigrated intra-utetrine contraceptive devices (IUD). In experienced hands, the operative laparoscope can also be used for their retrieval, thus avoiding exploratory laparotomy. Three case reports of perforated IUDs removed by Laparoscopy at B. Y. L. Nair Hospital are reported here.
| :: Case report|| |
Mrs. K. S., 28 year old second para, presented with menorrhagia following a Lippes' loop inserted seven months ago. On per speculum examination, loop threads could not be seen; sounding of the uterine cavity was negative. X-rays taken with uterine sound (AP and lateral view) showed the 'opened out' loop lying outside and posterior to the uterus in an upside down position. Laparoscopy done by the author revealed the IUD attached to the posterior surface of the uterus with few flimsy avascular adhesions.
The IUD was grasped with prongs of a band applicator and on giving a sharp pull it was separated from the uterus. The operative scope was then withdrawn till the IUD was held firmly between the prongs and edge of the trocar; then the whole assembly (trocar and scope) was removed. The IUD was thus recovered intact with the threads attached and an exploratory laparotomy was avoided.
Mrs. S, a 23 year old 1st para reported with complaints of leucorrhea and backache. She had a Copper T inserted following an MTP done 3 months ago. Per speculum examination showed a cervical erosion and non-specific vaginitis; loop threads were not seen. On sounding, the loop could be felt on the posterior wall, but could not be removed. X-ray pelvis AP and lateral view with uterine sound showed the loop lying in an oblique position above the tip of the uterine sound. A hysteroscopy combined with Laparoscopy was performed. Hysteroscopy done with CO2 hysteroflator showed only the ball of the vertical stem of CuT near the left cornual end; no threads were seen. Laparoscopy showed the CuT perforating the posterior wall on the left side. There were no adhesions. It was removed with the prongs of a band applicator as in the previous case. A thorough curettage failed to recover the missing threads.
Mrs. M.S., a 33 year old multipara was referred from urology OPD with an IVP done to rule out renal stone. The X-ray showed a CuT lying obliquely over the right sacro-iliac synchondrosis. On enquiry, she confessed that she had a loop inserted 4 years ago following an MTP; however, she had it removed about 2 years ago She was not shown the loop after removal. Laparoscopy done with an operative scope revealed the loop lying on the right pelvic wall. There were dust a few flmsy adhesions between the loop and the parietal peritoneum. The IUD was caught with the prongs of a band applicator and a few gentle pulls were given to break the adhesions. It was then removed as in the previous cases.
| :: Discussion|| |
It is evident from the above case reports that operative laparoscope can be successfully used for removal of transmigrated or perforated intra-uterine devices. This excploratory laparotomy can be avoided.
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