İnci KAHYAOĞLU, Şadıman KIYKAÇ ALTINBAŞ, Bülent DEDE, Ömer Lütfi TAPISIZ, Bülent YİRCİ, Füsun BOCUTOĞLU, Çağatayhan ÖZTÜRK, Sezin ERTÜRK AKSAKAL

Tuboovaryan Abse Kliniği ile Prezente, İleuma İnvaze Rahim İçi Aracın İzlendiği Nadir Bir Olgu Sunumu

Bu yazıda, tuboovaryan abse kliniği ve myometriyuma invaze RİA nedeni ile opere edilen ve RİA'nın ileuma penetre olduğu izlenen nadir bir vakayı sunmayı amaçladık. Otozsekiz yaşında, yaklaşık 7 yıl önce dış merkezde Cooper-T RİA uygulanmış hasta tuboovaryan abse tanısıyla kliniğimize yatırıldı. On iki gün parenteral gentamisin ve klindamisin antibiyotik tedavisine rağmen hastanın klinik bulgularının sebat etmesi üzerine tedavisi seftriakson ve metronidazol olacak şekilde yeniden düzenlendi ve operasyon kararı alındı. Önce vajinal yoldan ultrasonografi eşliğinde posterior forniksten abse lojuna enjektör ile girilerek yaklaşık 200 cc pürülan yoğun kıvamlı içerik aspire edildi. Ardından histeroskopiye geçildi. Zorlanmaksızın çekilmesine rağmen RİA'nın alınamaması üzerine laparoskopiye geçildi. Gözlemde, ileum ve sigmoid kolonun omentum ile konglomerat oluşturarak fundusa ve uterus arkasına dens şekilde yapıştığı, RİA'nın gövdesinin myometriyuma gömülü, T kollarının ise ileum lümeni içerisinde olduğu görüldü ve laparatomiye geçildi. İleum rezeke edildi. Ardından ileal yan yana anastamoz ve loop ileostomi açıldı. Aylık takiplerinde herhangi bir sorun olmayan hastanın postoperatif 3. ayda loop ileostomisi kapatıldı. Perforasyon ve migrasyonun asemptomatik olarak gerçekleşebilmesi ve buna bağlı komplikasyonlar nedeniyle rahim içi araçların yerleşimleri şikâyetten bağımsız olarak rutin kontrol edilmelidir.

Surgical Removal of an Intrauterine Device Invaded into Ileum and Resulted as a Tubo-Ovarianabscess

We present a case of a symptomatic perforation by an intrauterine device (IUD) into ileum resulted as a tubo-ovarian abscess. A 38-year old patient, who received TCu 380A in approximately 7 years ago, presented at the outpatient clinic with tubo-ovarian abscess. The patient received a 12-day course of antibiotic regimen intravenously. Clinical findings persisted despite upon antibiotic treatment. Then it was decided to operate the patient. Transvaginal ultrasound-guided drainage of tuboovarian abscess with concomitant hysteroscopy procedure was decided. Almost 200 mL of purulent, dense, brownish pus was drained until it was completely emptied and hysteroscopy was performed to remove the IUD. There was a negative pressure when aimed to pull out with the resectoscope, and gave a feeling that it was invaded into a visceral organ, therefore laparoscopy was performed . In exploratory laparoscopy, it was observed that ileum and sigmoid colon were conglomerated and attached densely on fundus, and cul-de-sac was totally obliterated. The two flexible side arms were embedded inside the ileum. It was decided to proceed to laparotomy. IUD was removed from the defect. 15 cm of ileum was resected, and loop ileostomy was performed. Clinical evaluation at monthly was uneventful and loop-ileostomy was closed at 3 months postoperative. Perforation of the uterus should be kept in mind in which IUDs are not visible in the uterine cavity.

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