Lim Kia Hui, Lee Jill C
Department of Obstetrics and Gynaecology, National University Hospital, Singapore, SGP.
Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, SGP.
Cureus. 2025 Aug 15;17(8):e90186. doi: 10.7759/cureus.90186. eCollection 2025 Aug.
The levonorgestrel-releasing intrauterine system (LNG-IUS) is a widely used long-acting reversible contraceptive, offering high efficacy and therapeutic benefits. Although generally safe, mechanical complications such as malposition, perforation, or retained components can occur. We report a case of concealed LNG-IUS arms in a perimenopausal patient following a difficult insertion, illustrating a rare but clinically significant complication. Challenging insertions or removals, particularly in patients with a narrowed cervix or uterine anatomical changes, should raise suspicion for suboptimal device placement. When malposition is suspected, orthogonal two-dimensional (2D) transvaginal ultrasound views can improve visualization and guide management. Awareness of arm retraction within the hormonal sleeve is essential to avoid unnecessary imaging or surgical intervention. Thorough device inspection, including sleeve dissection when required, should be the first step when missing arms are suspected. This report emphasizes the importance of anticipating complications during difficult LNG-IUS insertions or removals and outlines practical diagnostic strategies for suspected malposition, maldeployment, or retained components.
左炔诺孕酮宫内节育系统（LNG-IUS）是一种广泛使用的长效可逆避孕方法，具有高效性和治疗益处。尽管通常安全，但可能会出现诸如位置异常、穿孔或部件残留等机械并发症。我们报告一例围绝经期患者在困难插入后LNG-IUS臂部隐匿的病例，说明了一种罕见但具有临床意义的并发症。具有挑战性的插入或取出操作，尤其是在宫颈狭窄或子宫解剖结构改变的患者中，应提高对装置放置不佳的怀疑。当怀疑位置异常时，正交二维（2D）经阴道超声检查可以改善可视化并指导处理。了解激素套内臂部回缩情况对于避免不必要的影像学检查或手术干预至关重要。当怀疑臂部缺失时，彻底检查装置，包括必要时进行套囊解剖，应是第一步。本报告强调了在困难的LNG-IUS插入或取出过程中预见并发症的重要性，并概述了疑似位置异常、放置不当或部件残留的实用诊断策略。
