Fuller Robert R, Roddenberry Eric
Medical Center of Central Georgia, Macon, USA.
J Reprod Med. 2006 Sep;51(9):753-6.
Recent-onset chronic pelvic pain thought to originate from an intraomental Dalkon Shield intrauterine device (IUD) (A. H. Robbins, Inc., Richmond, Virginia) that had remained asymptomatic for over 30 years is unusual. Case reports and patient series suggest that intraomental IUDs remain asymptomatic for long periods of time and are usually not associated with chronic pelvic pain.
A 49-year-old woman with an unrecollected history of Dalkon Shield placement 30 years earlier was evaluated after 6 months of pelvic pain. A negative workup and failure of conservative management prompted an abdominal hysterectomy with bilateral salpingooophorectomy, which failed to relieve the symptoms. Revaluation identified a mobile, intraabdominal Dalkon Shield. Real-time x-ray fluoroscopy and reverse Trendelenburg positioning were used to laparoscopically retrieve the IUD from the patient's benign-appearing omentum. The pelvic pain remained resolved for over 1 year after removal of the IUD.
An intraomental IUD that remained asymptomatic for 30 years was the most likely source of chronic pelvic pain in this perimenopausal patient. Increased intraabdominal fat deposition associated with the perimenopause may have contributed to this patient's change in clinical status.
近期出现的慢性盆腔疼痛被认为源于一枚腹腔内达康盾宫内节育器（IUD）（A.H.罗宾斯公司，弗吉尼亚州里士满），该节育器已无症状存在30多年，这种情况并不常见。病例报告和患者系列研究表明，腹腔内IUD可长时间无症状，通常与慢性盆腔疼痛无关。
一名49岁女性，30年前放置达康盾节育器的病史已无法回忆，在经历6个月的盆腔疼痛后接受评估。检查结果为阴性且保守治疗无效，促使进行了腹式子宫切除术及双侧输卵管卵巢切除术，但症状仍未缓解。重新评估发现一枚可移动的腹腔内达康盾。通过实时X线透视和头低足高位，在腹腔镜下从患者外观正常的大网膜中取出了IUD。取出IUD后，盆腔疼痛持续缓解超过1年。
这枚无症状存在30年的腹腔内IUD最有可能是该围绝经期患者慢性盆腔疼痛的根源。围绝经期相关的腹腔内脂肪沉积增加可能导致了该患者临床状况的改变。
