Nedim ÇİÇEK, Özlem Gün ERYILMAZ, Esma SARIKAYA, Özlem MORALOĞLU, Senem Mine YAVUZ, HACER CAVİDAN GÜLERMAN

Clinical presentation, diagnosis and management of intra-abdominally dislocated intrauterine devices

Amaç: Uterin perforasyon, intrauterin kontraseptif aletlerin en ciddi komplikasyonudur ve hayatı tehdit edici olabilir. Bu çalışmada intraabdominal olarak disloke olmuş intrauterin kontraseptif aletlerin klinik prezentasyonları, tanıları ve cerrahi tedavileri ile ilgili tecrübemizi rapor ediyoruz. Materyal ve Metot: İntraabdominal olarak disloke olmuş intrauterin kontraseptif aletleri olan toplam 17 hasta retrospektif olarak incelendi. Hastaların tanıları jinekolojik muayene, transvajinal ultrasonografi ve abdominal X-ray ile konmuştu. Bulgular: Jinekolojik muayene sırasında iplerin görülememesi perforasyonun ilk bulgusu idi. Sadece 3 hasta karın ağrısından şikayetçi idi. Aletlerin 12 tanesi sertifikalı aile hekimleri tarafından, 5 tanesi de jinekologlar tarafından yerleştirilmişti. Aletler bütün hastalarda laparaskopi ile başarılı bir şekilde çıkarıldı fakat 4 hastada kolonik defektlerin tamiri için laparotomiye geçildi. Sonuç: Jinekolojik muayene sırasında intrauterin kontraseptif aletin ipi görülemezse, aletin lokalize edilmesi önemlidir. Histeroskopi ve ileri laparoskopi, perfore olan aletlerin tanısı ve tedavisine en uygun minimal invazif yaklaşımlardır.

Anahtar Kelimeler:

Laparoskopi, Uterus delinmesi, Rahimiçi araç göçü, Rahim içi araçlar, Tanı, Rahimiçi aracın çıkması

Abdomen içerisinde disloke olan intrauterin cihazların klinik prezentasyonu, tanısı ve yönetimi

Background: Uterine perforation is the most serious complication of intrauterine contraceptive devices (IUDs) and could be life threatening. We report on our experience in the clinical presentations, diagnosis and surgical treatment of patients with intraabdominally, dislocated IUDs. Materials and Methods: A total of 17 patients with an IUD located intraabdominally were retrospectively analyzed. Diagnosis was based on gynecologic examination, transvaginal sonography, and abdominal X-ray. Results: Missing strings during gynaecologic examination were the first sign of an expulsion. Only 3 patients complained of any abdominal pain. Twelve were inserted by general practitioners and five by specialist gynecologists. The successful removal of IUD was performed in all patients by laparoscopy, but four of the patients needed additional laparotomy to repair colonic defects. Conclusions: If the string of the IUD is not observed during gynecologic examination, it is important to locate it. Hysteroscopy and advanced laparoscopy, are ideally suited minimally invasive techniques, to the diagnosis and surgical management of the perforated IUD.

Keywords:

Laparoscopy, Uterine Perforation, Intrauterine Device Migration, Intrauterine Devices, Diagnosis, Intrauterine Device Expulsion,

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