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  • Title: Massive hemoperitoneum due to IUD.
    Author: Goldman JA, Feldberg D, Dicker D.
    Journal: Eur J Obstet Gynecol Reprod Biol; 1983 Jan; 14(4):239-40. PubMed ID: 6832447.
    Abstract:
    A case report of a rather uncommon and serious IUD complication, i.e., the occurrence of massive hemoperitoneum as a result of partial perforation of the uterus by a Lippes Loop IUD, is reported. A 33-year old woman, gravida 4, para 4, was admitted to an Israeli hospital in satisfactory general condition because of diffuse lower abdominal pain accompanied by vaginal staining. Past history revealed no severe previous illness. The woman's periods were regular with the last menstrual period occurring 25 days prior to admission. A Lippes Loop IUD had been inserted 1 year earlier but had caused no discomfort or side effects. On examination the lower abdomen was tender but no rebound tenderness was elicited. Pelvic examination revealed a markedly tender uterus and adnexa. No masses were palpated. Slight intraperitoneal bleeding was suspected, possibly because of ectopic pregnancy or bleeding corpus luteum. The IUD was removed by pulling on the strings which were visible. The procedure was relatively easy but caused marked pain to the patient. Several hours later she complained of diffuse abdominal pain and on palpation the entire abdomen was very tender and patulous. Her condition deteriorated rapidly; she was in shock. An emergency laparotomy was performed. On opening the peritoneal cavity, a large amount of 2000 ml fresh blood and blood clots was observed. The adnexa were found to be normal. On further exploration, a tear of approximately 15 mm was located in the anterior wall of the uterus below the fundus, with active bleeding from a tiny blood vessel. The tear was repaired. The postoperative course was uneventful. The case described seems to represent an instance of embedding of an IUD. Whether complete perforation occurred during intercourse or upon removal is unclear. It is assumed that the IUD in this case was a type 1-2 perforation, i.e., part in the uterine cavity and part in the myometrium, with a degree of variation of the major portion being in the uterine cavity and only a small part in myometrium since insertion or some time following it, with a different degree of the variety, or the IUD only slightly in the uterine cavity with a large degree of myometrial perforation after removal. It is suggested that if a problem is encountered during IUD removal and transmigration of an IUD is suspected, no attempts should be made to remove it per vagina even if the strings are palpable. Under these circumstances, the type and degree of perforation should be diagnosed and its removal by laparotomy or laparoscopy must be considered.
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