Loveless Alita, Dhari Ammar, Kilpatrick Charlie C
Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
J Reprod Med. 2014 Nov-Dec;59(11-12):611-3.
Complications arising from use of the levonorgestrel-releasing intrauterine system (LNG-IUS) are uncommon. Perforation of the uterus by an LNG-IUS leading to small bowel obstruction (SBO) has not been reported in the literature.
A 29-year-old woman presented to the emergency department with abdominal pain, constipation, nausea, and vomiting. CT scan revealed dilated loops of small bowel suggestive of SBO and an IUD that did not appear within the uterine cavity. Laparoscopy revealed a dense adhesive band of tissue extending from 2 cm caudad to the umbilical port site to 1 arm of the perforated LNG-IUS at the posterior uterine wall. Two bowel loops were twisted around the adhesive band multiple times. The band was taken down at the IUD and the bowel loops were spontaneously freed. The LNG-IUS was removed.
Use of the LNG-IUS is on the rise in the United States and is a recommended first-line contraceptive agent in the obese patient. Management of perforated IUD in an obese patient should take into account individual patient characteristics. Laparoscopic management of a SBO due to a perforated IUD in an obese patient is possible.
使用左炔诺孕酮宫内节育系统（LNG - IUS）引起的并发症并不常见。文献中尚未报道过LNG - IUS导致子宫穿孔进而引起小肠梗阻（SBO）的情况。
一名29岁女性因腹痛、便秘、恶心和呕吐就诊于急诊科。CT扫描显示小肠肠袢扩张，提示SBO，且宫腔内未见宫内节育器。腹腔镜检查发现一条致密的组织粘连带，从脐部端口下方2厘米处延伸至子宫后壁穿孔的LNG - IUS的一个臂。两个肠袢多次缠绕在粘连带上。在宫内节育器处松解粘连带，肠袢自行松解。取出LNG - IUS。
在美国，LNG - IUS的使用正在增加，并且是肥胖患者推荐的一线避孕药物。肥胖患者宫内节育器穿孔的处理应考虑个体患者特征。肥胖患者因宫内节育器穿孔导致SBO的腹腔镜处理是可行的。
