INTRAABDOMINAL MIGRATINGINTRAABDOMINAL MIGRATING of the of the INTRAUTERINE CONTRACEPTIVE DEVICE INTRAUTERINE CONTRACEPTIVE DEVICE

(IUD)(IUD)

HUNG THIEN NGUYEN, TRUNG CHI HO, CONG VAN NGUYEN, HAI THANH PHANHUNG THIEN NGUYEN, TRUNG CHI HO, CONG VAN NGUYEN, HAI THANH PHAN

MEDIC MEDICAL CENTER, HCMC, VIETNAMMEDIC MEDICAL CENTER, HCMC, VIETNAM

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INTRODUCTION:INTRODUCTION:

Migration of IUD may happen in women Migration of IUD may happen in women who choose this measure to prevent the who choose this measure to prevent the pregnancy. pregnancy.

Ultrasound can clearly view the IUD inside Ultrasound can clearly view the IUD inside the uterus. the uterus.

But sometimes could not reveal any IUD in But sometimes could not reveal any IUD in whom said having an IUD.whom said having an IUD.

OBJECTIVE:OBJECTIVE:

To compare ultrasound, X-rays and To compare ultrasound, X-rays and CT in detection of migrating IUD.CT in detection of migrating IUD.

MATERIAL and METHODS:MATERIAL and METHODS:

A descriptive, cross-sectional prospective A descriptive, cross-sectional prospective study from 2005 to 2010 in Medic Medical study from 2005 to 2010 in Medic Medical Center, HCM City. Center, HCM City.

When X-rays detects a mispositioned IUD When X-rays detects a mispositioned IUD the patient will be reexamined by the patient will be reexamined by ultrasound and then by CT. ultrasound and then by CT.

RESULTS:RESULTS:

05 cases of uncomplicated migrating and 05 cases of uncomplicated migrating and 01 case of complicated migrating. 01 case of complicated migrating.

All of uncomplicated cases happened in All of uncomplicated cases happened in over 50 year-old patients without clinical over 50 year-old patients without clinical signs.signs.

Most of cases with Dana IUD type, and one Most of cases with Dana IUD type, and one case had removed the uterus (case 5).case had removed the uterus (case 5).

RESULTS: (cont.)RESULTS: (cont.)

5/6 cases without complication 5/6 cases without complication One case having perforation of the rectum One case having perforation of the rectum

with two T shape type IUDs. with two T shape type IUDs. One other case has 2 kinds of IUD together One other case has 2 kinds of IUD together

(case 4): one Dana and other T shape IUD (case 4): one Dana and other T shape IUD type.type.

DISCUSSIONS:DISCUSSIONS:

Only one case on the left side. 4/6 cases Only one case on the left side. 4/6 cases on the right side. No clinical signs were on the right side. No clinical signs were noted.noted.

Ultrasound itself cannot disclose migrating Ultrasound itself cannot disclose migrating IUD. Ultrasound failed to detect an IUD. Ultrasound failed to detect an intraabdominal IUD (case 3).intraabdominal IUD (case 3).

Intra-abdominal IUDs were uncertain Intra-abdominal IUDs were uncertain masses of 21-45mm with mixed and masses of 21-45mm with mixed and hyperechoic pattern without acoustic hyperechoic pattern without acoustic shadowing. shadowing.

A 42yo female patient suffered from bloody stool. 2 years before she came to change her IUD which set up for 10 years, since then she usually got abdominal pain with bloody stool. In ultrasound examination, there is an T shape IUD into the uterus and a hyperechoic focal into the rectum. Later, CT scan confirmed 2 IUDs in the same patient, one into the uterus and others into the rectum. Endoscopic result proved that one IUD in penetrating the rectum which explained the bloody stool and her abdominal pain.

One case of double T shape IUDs with one perforating the rectum:

One case of double T shape IUDs with one perforating the rectum:

CONCLUSIONS:CONCLUSIONS:

Migration of IUD may happen in women Migration of IUD may happen in women having IUD.having IUD.

X-rays: detects effectively the intra and X-rays: detects effectively the intra and extrauterine IUD.extrauterine IUD.

Ultrasound: discloses difficultly Ultrasound: discloses difficultly intraabdominal migrating cases. intraabdominal migrating cases.

CT scan: reveals exactly the migrating IUD CT scan: reveals exactly the migrating IUD inside / outside of hollow viscera (uterine inside / outside of hollow viscera (uterine tube, bladder, colon, appendix). tube, bladder, colon, appendix).

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