IUCD perforation

IUCD (intrauterine contraceptive device) related uterine perforations are one of the causes of uterine perforation. It is a rare, but serious complication of an IUCD, and is often clinically silent.

Epidemiology

The incidence rate is reported at ~2 in 1000 .

Clinical presentation

Perforation at the time of insertion may be clinically silent or cause significant pelvic pain. A late perforation may be asymptomatic, or present with non-specific lower abdominal pain. In all cases, the visible 'strings' will be missing at direct inspection. Peritoneal sepsis is a rare presentation.

Pathology

IUCD perforation ranges from embedment in the myometrium to complete transuterine perforation with a migration of the IUCD into the peritoneal cavity .

Embedment refers to the penetration of IUCD into the endometrium or myometrium without extending through the serosa.

Intra-abdominal migration occurs when the IUCD is freely floating in the abdomen or pelvis encased in adhesions or adherent to bowel or the omentum. Adhesions can lead to infertility, chronic pain, and intestinal obstruction .

Associations
  • atrophic / postpartum uterus
  • uterine structural abnormalities
  • large fibroids

Radiographic features

Ultrasound is the recommended first-line investigation  in all women in whom the ‘strings’ cannot be visualized. Orthogonal radiographs are often the second line. CT can be used in complex cases where visceral involvement or surgical difficulty is suspected.

Plain radiograph
  • an IUCD lying lateral to midline may suggest the diagnosis
Ultrasound
  • may have a normal endometrial cavity on ultrasound
  • hyperechoic linear structure lying outside the uterus

Treatment and prognosis

Treatment depends on the degree of perforation and whether there are any complications (such as peritoneal sepsis or intestinal obstruction).

See also