Uterine perforation by an intrauterine device is known for ages. The incidence has fallen with the use of devices that use the withdrawal technique instead of the older push-out technique. The T-shaped devices have a higher incidence of downward perforation of the cervix by the stem, the uterine contractions driving the device downwards.
Today I found a curious mode of uterine perforation by Copper-T 380. The woman had had two cesarean sections in the past. She underwent a Copper-T 380 insertion postmenstrually 6 months ago. She came for a check up after 6 months, when the threads of the device were found to be missing. An ultrasonographic examination of the pelvis showed the device to be located in the right adnexal structures. Anteroposterior and lateral radiographs of the pelvis with a uterine sound in the uterine cavity also showed the device lateral to the uterus on the right side. We performed a laparoscopy on her. The threads of Copper-T were seen protruding through a small hole in the posterior leaf of the right broad ligament at the bottom. The ball at the tip of the vertical limb was just seen. We extracted the Copper-T by making traction on the threads. Half a milliliter of pus escaped with it. The patient made an uneventful recovery and was sent home the next day on antibiotics. It was curious that the lower end of the device had perforated into the right broad ligament, not into the cervix. It was even more curious that the threads had escaped into the peritoneal cavity first while the device remained in the broad ligament. What drove the device so far laterally is beyond imagination.
The initial appearance of the Copper-T is shown below.
The Copper-T is seen after extraction from the broad ligament.
Uterine perforation by an intrauterine device is known for ages. The incidence has fallen with the use of devices that use the withdrawal technique instead of the older push-out technique. The T-shaped devices have a higher incidence of downward perforation of the cervix by the stem, the uterine contractions driving the device downwards.
Today I found a curious mode of uterine perforation by Copper-T 380. The woman had had two cesarean sections in the past. She underwent a Copper-T 380 insertion postmenstrually 6 months ago. She came for a check up after 6 months, when the threads of the device were found to be missing. An ultrasonographic examination of the pelvis showed the device to be located in the right adnexal structures. Anteroposterior and lateral radiographs of the pelvis with a uterine sound in the uterine cavity also showed the device lateral to the uterus on the right side. We performed a laparoscopy on her. The threads of Copper-T were seen protruding through a small hole in the posterior leaf of the right broad ligament at the bottom. The ball at the tip of the vertical limb was just seen. We extracted the Copper-T by making traction on the threads. Half a milliliter of pus escaped with it. The patient made an uneventful recovery and was sent home the next day on antibiotics. It was curious that the lower end of the device had perforated into the right broad ligament, not into the cervix. It was even more curious that the threads had escaped into the peritoneal cavity first while the device remained in the broad ligament. What drove the device so far laterally is beyond imagination.
The initial appearance of the Copper-T is shown below.
The Copper-T is seen after extraction from the broad ligament.
