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Clinical Images  |   February 2013
Intrauterine Device–Related Uterine Perforation
Author Notes
  • From West Virginia University School of Medicine, Eastern Division, in Martinsburg 
  • Address correspondence to James F. Murray, DO, Western Virginia University Women's Health Center, 203 E 4th Ave, Ranson, WV 25438-1617. E-mail: murrayja@wvuhealthcare.com  
Article Information
Imaging / Obstetrics and Gynecology / Clinical Images
Clinical Images   |   February 2013
Intrauterine Device–Related Uterine Perforation
The Journal of the American Osteopathic Association, February 2013, Vol. 113, 178. doi:10.7556/jaoa.2013.113.2.178
The Journal of the American Osteopathic Association, February 2013, Vol. 113, 178. doi:10.7556/jaoa.2013.113.2.178
Web of Science® Times Cited: 6
A parous woman who received a hormonal intrauterine device (IUD) 9 months prior presented to our emergency department with a 2-day history of worsening chronic abdominal pain. She reported fever, chills, nausea, emesis, and pain over her right lower quadrant radiating to her ipsilateral flank and groin. Her medical history included pelvic congestion syndrome and ovarian vein thrombosis. Abdominal examination revealed right lower quadrant tenderness with minimal guarding on palpation. Vital signs, complete blood cell count, and urinalysis results were normal. Computed tomography scans of the abdomen and pelvis in the sagittal view revealed that an IUD limb had extended beyond the uterine margins, which raised concern for uterine perforation (image A). Transvaginal ultrasonography results confirmed an embedment-type IUD perforation into the myometrium (image B). Hysteroscopy was performed for IUD removal, which relieved the patient's abdominal pain. 
   Financial Disclosures: None reported.
 
Suggested Reading
Suggested Reading
Gill RS, Mok D, Hudson M, Shi X, Birch DW, Karmali S. Laparoscopic removal of an intra-abdominal intrauterine device: case and systematic review. Contraception. 2012;85(1):15-18. doi:10.1016/j.contraception.2011.04.015. [CrossRef] [PubMed]
Heinberg EM, McCoy TW, Pasic R. The perforated intrauterine device: endoscopic retrieval. JSLS. 2008;12(1):97-100. [PubMed]