Removal of completely perforating IUDs by explorative laparotomy

Abstract

Nine patients with completely perforating intrauterine contraceptive devices are presented. In all cases, the device was removed by explorative laparotomy. In eight out of the nine women, the device was found to be embedded in the omentum or vesical peritoneal plica. The advantages of explorative laparotomy over laparoscopy or colpotomy are emphasized.

PIP: The use of laparotomy for removal of completely perforating IUDs was reviewed. A table summarizes the clinical details of 9 patients who sought removal of completely perforating IUDs at the Carmel Medical Center, Haifa, Israel, between 1979-83. The patients varied in age between 23-46 years. Only 2 of the 9 patients had reported pain during the IUD insertion. Predisposing factors that may explain the perforation were found in patient 3 (cesarean section), patient 4 (grand multipara), and patients 6, 7, and 8 (6-10 weeks postpartum). 5 of the IUDs were Lippes loops; the others were Cu-7s. All patients were asymptomatic. In 6 cases, the IUDs were deeply embedded in the omentum; in 2 cases the IUDs were found free in the posterior cul de sac. In all cases in which the IUDs were embedded, the removal was difficult and required fine dissection of the adhesions between the device and the surrounding tissues. As the routine investigations failed to show whether the perforating IUDs were embedded or free in the abdominal cavity, it is advisable to remove such devices by explorative laparotomy.