Barber Michelle, Chalifour Daryl S, Anderson Maria R
Assistant Professor/Faculty Clinician, Palmer College of Chiropractic, Davenport, IA 52803.
J Chiropr Med. 2011 Jun;10(2):126-9. doi: 10.1016/j.jcm.2010.11.001. Epub 2011 Apr 5.
The purpose of this case report is to describe the case of a 24-year-old woman complaining of diffuse abdominal pain following insertion of an intrauterine contraceptive device (IUC).
A 24-year-old woman, 8 weeks postpartum, sought chiropractic care for intermittent stabbing pain in her left upper quadrant that had been present for a week. She returned 1 week later with no resolution of her complaint. She then recalled that, at her 6-week gynecological examination, she had undergone insertion of an IUC and that the abdominal pain had begun a week later. She was advised to return to her gynecologist. Subsequent evaluation by the gynecologist revealed that the IUC had perforated her uterus and had migrated to the upper left quadrant of her abdomen, where it was found anterior to the L1-2 vertebral bodies, lying in contact with the anterior surface of the abdominal aorta. To our knowledge, this is the only report of this type of presentation in a chiropractic office.
The initial intervention with this patient included chiropractic adjustment and myofascial release. At her subsequent visit, with no resolution of her complaint, she was referred back to her gynecologist for additional evaluation. Because the IUC had perforated her uterus, she underwent emergency laparoscopic surgery. The surgery was successful, and she recovered fully.
Chiropractic physicians should consider uterine perforation by IUC in the differential diagnosis of a female patient of childbearing age seeking care for abdominal pain.
本病例报告旨在描述一名24岁女性在宫内节育器（IUC）置入后出现弥漫性腹痛的病例。
一名24岁、产后8周的女性因左上腹间歇性刺痛持续一周前来接受脊椎按摩治疗。一周后她复诊，症状仍未缓解。随后她回忆起在六周的妇科检查时置入了IUC，腹痛在一周后开始。建议她返回妇科医生处。妇科医生随后的评估显示，IUC已穿透她的子宫并迁移至左上腹，在L1 - 2椎体前方被发现，与腹主动脉前表面接触。据我们所知，这是脊椎按摩诊所此类病例的唯一报告。
对该患者的初始干预包括脊椎按摩调整和肌筋膜放松。在她随后的复诊中，症状仍未缓解，于是她被转回妇科医生处进行进一步评估。由于IUC已穿透子宫，她接受了急诊腹腔镜手术。手术成功，她完全康复。
脊椎按摩医生在对因腹痛前来就诊的育龄女性患者进行鉴别诊断时，应考虑IUC导致子宫穿孔的可能性。
