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Thứ Bảy, 5 tháng 2, 2011

INTRAABDOMINAL MIGRATING of INTRAUTERINE CONTRACEPTIVE DEVICES

INTRAABDOMINAL MIGRATING of  INTRAUTERINE CONTRACEPTIVE DEVICE
HUNG THIEN NGUYEN,  TRUNG CHI HO,  CONG VAN NGUYEN,  HAI THANH PHAN
MEDIC MEDICAL CENTER, HCMC, VIETNAM

ABSTRACT:


OBJECTIVE: To compare ultrasound, X-rays and CT in detection of  migrating IUD  because sometimes ultrasound could not reveal any IUD in whom said having an IUD. MATERIAL and METHODS: A descriptive, cross-sectional prospective study from 2005 to 2010 in Medic Medical Center, HCM City. When X-rays detects a mispositioned IUD the patient will be reexamined by ultrasound and  then by CT. RESULTS:05 cases of uncomplicated migrating and 01 case of complicated migrating. All of uncomplicated cases happened in over 50 year-old patients without clinical signs. Most of cases with Dana IUD type, and one case had removed the uterus (case 5). One case having perforation of the rectum with two T shape type IUDs. An other case has 2 kinds of IUD together (case 4): one Dana and other T shape IUD type. DISCUSSIONS: One case on the left side.  4/6 cases on the right side. Ultrasound itself cannot disclose migrating IUD. Ultrasound failed to detect an intraabdominal IUD (case 3). Intra-abdominal migrating IUDs were uncertain masses of 21-45mm with mixed and hyperechoic pattern without acoustic shadowing. CONCLUSIONS: Migration of IUD may happen in women having IUD. X-rays has effective role to detect the intra and extrauterine IUD. Ultrasound discloses difficultly intraabdominal migrating cases. CT scan reveals exactly the migrating IUD inside / outside of hollow viscera (uterine tube, bladder, colon, appendix).




INTRODUCTION:

Migration of IUD may happen in women who choose this measure to prevent the pregnancy. In routine examination, ultrasound can clearly view the IUD inside the uterus but sometimes coud not reveal any IUD in whom said having an IUD.

OBJECTIVE:

To compare  ultrasound, X-rays and CT scanning in detection of  migrating IUD .

MATERIAL and METHODS:

A descriptive, cross-sectional prospective study was performed from 2005 to 2010 at an out patient room in Medic Medical Center, HCM City. When X-rays detects a misplaced IUD the patient will be reexamined by ultrasound as a second look and then by CT scanning.

RESULTS:

We have 05 cases of uncomplicated migrating and 01 case of complicated migrating.

With complication
One case of double IUDs with one perforated the rectum: A 42yo female patient suffered from bloody stool. 2 years before she came to change her IUD which set up for 10 years, since then she usually got abdominal pain  and bloody stool. In ultrasound examination, there is an T shape IUD into the uterus and a hyperechoic focal into the rectum. Later, CT scan confirmed 2 IUDs in the same patient, one into the uterus and others into the rectum. Endoscopic result proved that one IUD in penetrating the rectum which explained the bloody stool and her abdominal pain.


Ultrasound reveals IUD T shape into the uterus and a hyperechoic focal into the rectum. Endoscopic result proved that one IUD in penetrating the rectum which explained the bloody stool and her abdominal pain.


Without complication

 05 cases met incidentally by X-rays plain abdominal films.

 All of cases happened in over 50 year-old patients without clinical signs.

 Most of cases with Dana IUD, one case (case 4) with 2 kinds of IUD together (Dana and T shape) and one case had removed the uterus (case 5).


Case 1: X-rays, Ultrasound and CT scan show an intraabdominal Dana IUD type at the right border of the liver.


 


Case 2: A Dana IUD type on the right, which X-rays and ultrasound represent it intraabdominal and close the abdominal wall.





Case 3: X-rays reveals an intraabdominal Dana IUD type in the epigastric area and ultrasound failed to detect it because of bowel gas.



Case 4: X-rays detect 2 types of IUD together in one patient: an intraabdominal Dana IUD type on right side and another T shape IUD type inside the uterus. Case 4: Ultrasound shows an intraabdominal Dana IUD type on right side and another T shape IUD type inside the uterus in one patient.




Case 5: X-rays and ultrasound show the intraabdominal Dana IUD type on the left side, near the abdominal wall, the uterus had been removed .




DISCUSSIONS:

 5/6 cases met without complication and one case with 2 T shape type IUD, one of  which  perforated the rectum and causes abdominal pain and bloody stool.

 In an uncomplicated case (1/6 cases) there were 2 kinds of IUD in the same patient: one Dana and other T shape IUD type.

 Most of cases happened with Dana type IUD (5/6 cases).

 Patients in over 50 years of age, intra-addominal IUDs usually appear on the right site, only one on the left side of abdominal cavity.

 Ultrasound itself cannot disclose migrating IUD. In one case ultrasound failed to detect the intraabdominal IUD (case 3) at the epigastrum (1/6 cases). By ultrasound, intra-abdominal migrating IUDs were uncertain masses of 21-45mm with mixed and hyperechoic pattern without acoustic shadowing. It may be due to the Dana type IUD which has a poor shadowing behind the device.

 4/6 cases of migration to the right side of abdominal cavity were noted and the pathogenesis may be the same with the collection of free fluid in the acute abdomen. Causes of migration are still unclear. That may be thought about the contraction of uterus or an unexpected perforation of the uterus.

CONCLUSIONS:

Migration of IUD may happen in women who choose this measure to prevent the pregnancy. X-rays has the effective role to detect the intra and extrauterine IUD. Ultrasound may help in certain cases and CT scan could detect exactly the migrating IUD inside or outside of  hollow viscera (uterine tube, bladder, colon, appendix).

REFERENCES


1. Dan Vadim Valsky,  Sarah M. Cohen,  Drorith Hochner-Celnikier, Achinoam Lev-Sagie,  Simcha Yagel :The Shadow of the Intrauterine Device, J Ultrasound Med 2006; 25:613–616.
2. Nagamani Peri, David Graham,  Deborah Levine: Imaging of Intrauterine Contraceptive Devices, J Ultrasound Med 2007; 26:1389–1401.

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