Diagnosis and management of intra-abdominal, mislocated intrauterine devices

Abstract

Purpose: To evaluate the predisposing factors, diagnosis and surgical treatment options of patients with intra-abdominal, mislocated intrauterine devices (IUDs).

Methods: The diagnosis and management of 18 patients with intra-abdominal, mislocated IUDs were analyzed in this retrospective study.

Results: Trained midwives inserted ten (55%) of the IUDs, while six (33%) were inserted by general practitioners and two (11%) by specialist gynecologists. Ten (55.5%) of the patients were diagnosed by gynecological examination and ultrasonography (USG); abdominal X-ray, in addition, was required in the other eight (44.4%). Eleven patients (61%) were managed by laparoscopy, whereas laparotomy was required in seven (39%). For all patients, laparoscopy was performed initially. No complication was encountered in any of the patients.

Conclusion: Persons who insert IUDs should receive adequate training before certification, because inadequate pelvic examination before insertion and inexperience of the inserting person might be predisposing factors for uterine perforation. If IUD strings are not visible during gynecologic examination, USG should be tried to locate the IUD and pelvic X-ray used only when USG fails to locate the IUD. Laparoscopy can be the first choice for removal.