Sarver Jordan, Cregan Melissa, Cain Daniel
Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, United States of America.
Twins Springs Gynecology, Massillon, OH 44646, United States of America.
Case Rep Womens Health. 2021 Jan 23;29:e00287. doi: 10.1016/j.crwh.2021.e00287. eCollection 2021 Jan.
Several types of contraception methods exist, and among these are hormonal and non-hormonal intrauterine devices (IUDs). Cases have been reported of fractured IUD pieces and retention of copper fragments upon attempted removal in office. These findings suggest the importance of careful removal of an IUD by providers. A 38-year-old Caucasian woman, gravida 2, para 2, presented for a colposcopy and endometrial biopsy (EMB). She had had a copper IUD (ParaGard) placed 10 years prior. She now requested to have it removed. After completion of the colposcopy and EMB, the provider located the IUD strings for removal. During careful removal of the IUD, a piece was broken off and remained in the uterine cavity. Upon visual inspection of the removed IUD, the right wing was missing and presumed to be still in the patient. Transabdominal and transvaginal ultrasound (TVUS) confirmed presence of a portion of the IUD in the uterine wall near the cervix. The patient was scheduled for surgical removal of the IUD by robot-assisted total laparoscopic hysterectomy with bilateral salpingectomy. This case highlights the importance of thorough evaluation of an IUD upon removal. Practitioners who work with IUD insertion and removal should remain informed about this rare complication. Risk of fracture during IUD removal should be better communicated between physicians and patients. This case study underlines the importance of careful IUD planning, from insertion to removal. Further research considering improved stepwise removal should be considered.
存在多种避孕方法，其中包括激素和非激素宫内节育器（IUD）。已有报告称，在门诊试图取出IUD时出现了节育器碎片断裂和铜碎片残留的情况。这些发现表明，医疗服务提供者小心取出IUD非常重要。一名38岁的白种女性，孕2产2，前来进行阴道镜检查和子宫内膜活检（EMB）。她10年前放置了一枚铜质IUD（帕拉戈德）。她现在要求取出。在完成阴道镜检查和EMB后，医疗服务提供者找到了用于取出的IUD尾丝。在小心取出IUD的过程中，有一块碎片断裂并留在了子宫腔内。在目视检查取出的IUD时，发现右翼缺失，推测仍在患者体内。经腹和经阴道超声（TVUS）证实子宫颈附近的子宫壁内有一部分IUD。该患者计划通过机器人辅助全腹腔镜子宫切除术加双侧输卵管切除术手术取出IUD。这个病例突出了取出IUD时进行全面评估的重要性。从事IUD置入和取出工作的从业者应了解这种罕见的并发症。医生和患者之间应更好地沟通IUD取出过程中发生断裂的风险。本病例研究强调了从置入到取出IUD时精心规划的重要性。应考虑开展关于改进逐步取出方法的进一步研究。
