IUD placement is a widely used method of contraception in China and is currently recommended by the World Health Organization as a first-line contraceptive program, mainly with "T-shaped" or "round-shaped" IUDs. Compared with other methods, This method is relatively convenient, safe and effective, and highly compliant. It is easy to insert, and fertility can be restored by removing the IUD.
The scope of IUD perforation is variable, from the insertion of IUD to complete uterine perforation, destruction of the three uterine layers (endometrium, myometrium, and serous membrane), and migration of IUD to the peritoneal cavity Therefore, the perforation of the IUD is divided into four types: the first is when it is confined to the uterine cavity, the second is when the IUD is confined to the myometrium, and the third is when the peritoneal cavity is ruptured. Time. The fourth is when the IUD penetrates the surrounding organs.
An ectopic IUD often causes gynaecological symptoms such as abdominal pain, severe menstrual bleeding, prolonged menstruation, and unwanted pregnancy but its impact on other systems is often ignored. On the contrary, when other systems produce corresponding symptoms, the factor of ectopic IUD is often ignored.
① Complications caused by ectopic IUD to the urinary system: Malik, T et al. have reported that the IUD ectopic to the right ureter, leading to hydronephrosis and ureteral hydrops, Priyadarshi et al. reported that the IUD was transferred to the peritoneum. The lower part of the left ureter is stenosis, which blocks the left ureter, resulting in severe ureter and hydronephrosis. Omar S. Akhtar et al. reported 2 cases of bladder stones formed from ectopic to the bladder. Vahdat, M et al. reported that a scar defect caused by cesarean section caused the intrauterine device to migrate into the bladder cavity and bladder wall, resulting in secondary Cases of infertility.
②The ectopic IUD to the digestive system can cause intestinal strangulation, acute calculous cholecystitis, fistula and other emergencies. Mellow, S et al. once reported a case of severe abdominal pain and vomiting in a patient who went to the doctor with a history of severe abdominal pain and vomiting. A later detailed follow-up of the medical history revealed that IUCD was wrapped in the small intestine loop Its supporting mesenteric causes strangulation of the small intestine. Santos, A.P., etc. once reported a case of acute calculous cholecystitis caused by ectopic IUD, which reminds us that women of childbearing age should ask for detailed medical history when they develop digestive system diseases.
③The most common complication caused by ectopic IUD to the reproductive system is uterine perforation. Davoodabadi, A. once reported a case of invasion of the sigmoid colon through uterine perforation, which is likely to be missed.Yan, D. et al. once reported a rare case of vesicovaginal fistula and vaginal stones.Risk factors for perforation of the IUD include inexperienced doctors inserting the IUD, incorrect positioning of the IUD, abnormal uterus, multiple pregnancies, and recent miscarriage or pregnancy.
④The most common complications caused by ectopic IUD to pelvic organs are ureterorenal pelvis and calyx expansion, ureteral erosion and obstruction, and peritonitis. Therefore, the impact of ectopic IUD should be understood by more people.
Among the 5 cases reported by our hospital, 4 cases of IUD were ectopic to the bladder. Case 1 of this group went to the doctor due to symptoms of intermittent irritating urination and gross hematuria. After cystoscopy, the bladder was found to be ectopic to the bladder and bladder stones were formed. The intrauterine device and stones were successfully removed by laparoscopy. Case 2 in this group was asymptomatic and found ectopic to the bladder wall through cystoscopy. Laparoscopy was used to remove the ectopic IUD. Omar S. Akhtar et al. reported 2 cases. The IUD was removed by partial cystectomy via the abdomen. Case 3 in this group was found to be ectopic to the bladder after the removal of the vesicle tissue in the triangle area during the operation. Case 4 of this group was admitted to the hospital due to lower urinary tract symptoms. The cystoscope indicated cystitis glandularis, but CT found an ectopic IUD to the bladder. Hysteroscopy was used to remove the ectopic IUD in both cases. Case 5 of this group is the ectopic of the IUD to the right side ureter outside the uterus. CT examination showed that the right hydronephrosis with dilatation of the upper part of the right ureter was suspected to be caused by the obstruction of the lower part of the ureter. Researchers used laparoscopic ureteral replantation. And laparoscopic removal of the free ectopic contraceptive ring. Xuesong Yang et al. reported 1 case. Ultrasound examination showed severe hydronephrosis and upper ureteral dilatation on the left side, abdominal X-ray (KUB) showed a left pelvic intrauterine device, pelvic computed tomography (CT) found The IUD is located very close to the lower part of the ureter. Researchers used a double J-shaped stent to be placed in the left ureter before the operation, and the IUD was taken out through laparoscopy for the first time. When the left side hydronephrosis worsened after 2 months, the second ureteroneocystostomy was performed.
Different surgical methods are selected for different ectopic positions and their effects. In the treatment methods reported in the literature review, all cases underwent surgical treatment (129/129, 100%), of which 65 cases underwent laparoscopic techniques (50.7%) and endoscopy (15.6%). Open surgery accounted for only 9%, intraoperative And there were no major complications after surgery. It can be seen that the use of laparoscopy to treat ectopic IUD is the choice of most doctors, but experienced clinicians should choose a suitable surgical method according to the different position of the ectopic and use minimally invasive techniques to remove the IUD as much as possible to relieve the ectopic IUD. Complications produced.
The ectopic IUD can cause a serious impact on multiple systems of the human body. Therefore, it is recommended that experienced gynaecologists use the correct intrauterine device implantation technology, but the spontaneous ectopic IUD cannot be controlled. Use imaging techniques such as ultrasound, Techniques such as CT scan and cystoscopy can determine the position of the intrauterine device. According to the location of the ectopic, select the appropriate surgical plan to remove the ectopic IUD and relieve the complications caused by the ectopic IUD. Our report aims to remind people that researchers must be alert to the loss of an ectopic intrauterine device that may cause serious damage to nearby organs.