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Thứ Sáu, 30 tháng 3, 2012

MIGRATION of INTRAUTERINE DEVICES


Intrauterine devices (IUDs) are a commonly used form of contraception worldwide. However, migration of the IUD from its normal position in the uterine fundus is a frequently encountered complication, varying from uterine expulsion to displacement into the endometrial canal to uterine perforation. Different sites of IUD translocation vary in terms of their clinical significance and subsequent management, and the urgency of communicating IUD migration to the clinician is likewise variable. Expulsion or intrauterine displacement of the IUD leads to decreased contraceptive efficacy and should be clearly communicated, since it warrants IUD replacement to prevent unplanned pregnancy. Embedment of the IUD into the myometrium can usually be managed in the outpatient clinical setting but occasionally requires hysteroscopic removal. Complete uterine perforation, in which the IUD is partially or completely within the peritoneal cavity, requires surgical management, and timely and direct communication with the clinician is essential in such cases. Careful evaluation for intraabdominal complications is also important, since they may warrant urgent or emergent surgical intervention. The radiologist plays an important role in the diagnosis of IUD migration and should be familiar with its appearance at multiple imaging modalities.
© RSNA, 2012
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An Interesting Case of T-Shape IUD Inducing Urinary Stone Formation for 10 Years at MEDIC CENTER, HCMC, Vietnam, Tai van Le, Triet Quang Duong, Nhan Thanh Nguyen Vo, Thien Minh Nguyen.

33yo female patient, PARA 4004, with chief complaints: hypogastric pain and dysuria for a long time.
 She used a T-shape IUD  after having a first child in 2002, but removed the IUD at the third month of the second pregnancy. She had more 2 another children from 2004 to 2008. And she reused IUD since then.
Ultrasound detected an intrauterine T-shape IUD and a foreign body inside urinary bladder with dirty shadowing.
Cystoscopy detected an adherent stone in urinary bladder (UB).

MDCT revealed 2 T-shape IUDs coexisting, one inside uterus, another perforating the uterus while the transversal tip of this IUD inserted the UB wall and inducing stone formation. The later IUD was a complicated migrating T-shape IUD.

At last, surgery removed the complicated migrating IUD which remained with 3 foeti, and proved that there were 2 IUDs coexisting in a patient, one of those inserted the UB wall and inducing UB stone formation.  

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