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  • Title: Asymptomatic perforation of the small intestine by a copper-7 intrauterine device.
    Author: Rochelson BL, Mann WJ, Fromowitz F, Baim R.
    Journal: N Y State J Med; 1985 Aug; 85(8):515-6. PubMed ID: 3863028.
    Abstract:
    The case of a 32-year old woman (gravida 3 para 2) in whom a Copper-7 IUD perforated the uterus, lodging both within the myometrium and the lumen of the small intestine is described. The patient presented in the emergency room 18 months after IUD insertion with heavy vaginal bleeding and passage of tissue. A diagnosis of spontaneous abortion was made. In this case, the small bowel had to be resected and side-to-side anastomosis was performed. This patient was asymptomatic until 3 weeks prior to admission. Other cases demonstrate acute symptoms of peritonitis and intestinal obstruction or more chronic complaints of vague abdominal pain and diarrhea. An IUD string that is not visible at the external os of the cervix generally reflects upward retraction of the string or unnoted spontaneous expulsion of the IUD. However, on occasion it can be associated with uterine or even intestinal perforation, as occurred in this case. Pain on insertion, also noted in this case, can serve as a warning sign of perforation. In this patient, the device was inserted 5 weeks after delivery, lending support to the recommendation that puerperal insertion be avoided. It is important to know the exact location of an ectopic IUD to prevent dangerous attempts at removal through the vagina. Laparoscopy and ultrasound are generally helpful in localizing the IUD and preparing the patient for laparotomy and possible bowel resection.
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