Discovery of a missing intrauterine system in the peritoneal cavity during cervical cancer surgery: a case report

Discovery of a missing intrauterine system in the peritoneal cavity during cervical cancer surgery: a case report

Authors

  • Stefano Restaino Clinic of Obstetrics and Gynecology, "Santa Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy https://orcid.org/0000-0002-7848-0329
  • Alice Poli Ospedale Santa Maria della Misericordia Udine
  • Martina Arcieri Clinic of Obstetrics and Gynecology, "Santa Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy https://orcid.org/0000-0002-8257-0618
  • Monica Della Martina Clinic of Obstetrics and Gynecology, "Santa Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
  • Giovanni Scambia Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy https://orcid.org/0000-0002-9503-9041
  • Lorenza Driul Clinic of Obstetrics and Gynecology, "Santa Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy - Department of Medicine, University of Udine, Udine, Italy https://orcid.org/0000-0003-1896-9410
  • Giuseppe Vizzielli Clinic of Obstetrics and Gynecology, "Santa Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy - Department of Medicine, University of Udine, Udine, Italy https://orcid.org/0000-0002-2424-2691

Keywords:

Intrauterine device, Uterine perforation, Migrated IUD, Abdominal imaging

Abstract

Background: Intrauterine devices (IUD) are the most commonly used form of long-acting, reversible contraception; however, they can rarely be complicated by perforation at insertion or migration. Migration in the abdomen can cause inflammation, fibrosis, chronic pain and can affect neighboring organs but it can also be asymptomatic. Methods: We report the case of a woman with a story of a missing levonorgestrel-releasing intrauterine device who didn’t undergo imaging to find the device and decided for the insertion of a second IUS. Then the missing device was discovered in her peritoneal cavity during surgery for cervical cancer. Results: The patient had at the same time the missing IUS in the peritoneal cavity and a correctly positioned IUS into the uterus and she had no symptoms related to the migrated IUS. Current literature reveals that up to 85% of patients with uterine perforation by IUD migration are asymptomatic. However, removal of the device is recommended, even in asymptomatic patients using minimally invasive methods if possible, including hysteroscopy, laparoscopy, cystoscopy, and colonoscopy depending on the location of the IUD. Conclusions: In a context of a missing IUD an abdominal imaging should be carried out to localize the device and its removal is recommended to avoid consequences. 

References

Carroll A, Paradise C, Schuemann K, Scott Schellhammer S, Carlan S.J. Far migration of an intrauterine contraceptive device from the uterus to the small bowel. Clin case rep. 2022. 10(3): e05589. doi: 10.1002/ccr3.5589.

Benaguida H, Kiram H, Telmoudi EC, et al. Intraperitoneal migration of an intrauterine device (IUD): A case report. Ann Med Surg. 2021. 8:68:102547. doi: 10.1016/j.amsu.2021.102547.

Jatlaoui TC, Riley HEM, Curtis KM. The safety of intrauterine devices among young women: a systematic review. Contraception. 2017. 95(1): 17–39. doi.org/10.1016/j.contraception.2016.10.006.

Konstantinos B, Marianna T, Medhat H. Incidental discovery of two levonorgestrel-releasing intrauterine systems misplaced in the peritoneal cavity. Eur J Contracept Reprod Health Care. 2010. 15(6):441-4. doi: 10.3109/13625187.2010.514081.

Mohamad S, Mahmoud, Zaher O. Merhi. Computed tomography-assisted laparoscopic removal of intraabdominally migrated levonorgestrel-releasing intrauterine systems. Arch Gynecol Obstet. 2010. 281(4):627-30. doi: 10.1007/s00404-009-1149-2.

Kyleena Prescribing Information. Drugs.com. Last updated on Jun 15, 2023.

Cibula D, Raspollini MR, Planchamp F, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer – Update 2023. Int J Gynecol Cancer. 2023. 33(5): 649-666. doi: 10.1136/ijgc-2023-004429.

Dominique A. Badr, Saadia M. Cheikh, Jihad M. Al Hassan, Mohamad K. Ramadan. Tubal Migration of Intrauterine Device: A Report of a Rare Case of Trauma-Induced Migration Leading to Acute Abdomen. J of Clin Gynecol Obstet. 2017. Volume 6, Number 3-4, pages 75-78. doi: https://doi.org/10.14740/jcgo453w.

Ferguson CA, Costescub D, Jamiesonc MA, Jongd L. Transmural migration and perforation of a levonorgestrel intrauterine system: a case report and review of the literature. Contraception. 2016. 93(1):81-6. doi: 10.1016/j.contraception.2015.08.019.

Barnett C, Moehner S, Do Minh T, Heinemann K. Perforation risk and intra-uterine devices: results of the EURAS-IUD 5-year extension study. Eur J Contracept Reprod Health Care. 2017. 22(6):424-428. doi: 10.1080/13625187.2017.1412427.

Van Grootheest K, Sachs B, Harrison-Woolrych M, Caduff-Janosa P, Van Puijenbroek E. Uterine Perforation with the Levonorgestrel-Releasing Intrauterine Device Analysis of Reports from Four National Pharmacovigilance Centres. Drug Saf. 2011. 34(1):83-8. doi: 10.2165/11585050-000000000-00000.

Ricci G, Restaino S, Di Lorenzo G, Fanfani F, Scrimin F, Mangino FP. Risk of Essure microinsert abdominal migration: case report and review of literature. Ther Clin Risk Manag. 2014. 17:10:963-8. doi: 10.2147/TCRM.S65634.

Gullo G, Cucinella G, Chiantera V, et al. Fertility-Sparing Strategies for Early-Stage Endometrial Cancer: Stepping towards Precision Medicine Based on the Molecular Fingerprint. Int J Mol Sci. 2023. 24(1):811. doi: 10.3390/ijms24010811.

Mutlu L, Manavella DD, Gullo G, McNamara B, Santin AD, Patrizio P. Endometrial Cancer in Reproductive Age: Fertility-Sparing Approach and Reproductive Outcomes. Cancers (Basel). 2022. 14(21):5187. doi: 10.3390/cancers14215187.

Gullo G, Perino A, Cucinella G. Open vs. closed vitrification system: which one is safer? Eur Rev Med Pharmacol Sci. 2022. 26(4):1065-1067. doi: 10.26355/eurrev_202202_28092.

Zaami S, Stark M, Signore F, Gullo G, Marinelli E. Fertility preservation in female cancer sufferers: (only) a moral obligation? Eur J Contracept Reprod Health Care. 2022. 27(4):335-340. doi: 10.1080/13625187.2022.2045936.

Downloads

Published

21-06-2024

Issue

Section

CASE REPORTS

How to Cite

1.
Restaino S, Poli A, Arcieri M, Della Martina M, Scambia G, Driul L, et al. Discovery of a missing intrauterine system in the peritoneal cavity during cervical cancer surgery: a case report. Acta Biomed [Internet]. 2024 Jun. 21 [cited 2024 Jul. 25];95(3):e2024038. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/15348