Intra-operative Detection of Asymptomatic Perforated Copper T- A Case Report

Abstract

Context: Uterine perforation is a rare yet important complication of the intrauterine device (IUD). Whereas many experts recommend removal of perforated IUD irrespective of symptomatic or not, no-touch is recommended when IUD is outside the uterus and IUD is surrounded and embedded in the fibrotic tissues: Attempting its removal may cause bleeding. Thus, asymptomatic perforation poses a management dilemma. Case Report: We report a patient with asymptomatic perforated IUD (copper T) incidentally detected intraoperatively, which we removed under mini-laparotomy. A 32-year-old pregnant woman (Gravida 5 Para 4) presented to us for Medical Termination of Pregnancy and laparoscopic tubal ligation. Vaginal examination revealed uterus of 10 week-size and bilateral fornices were free and non-tender. Transvaginal ultrasound revealed a single live intrauterine embryo of 10 week-size. Laparoscopy revealed that the left cornu of the uterus was perforated, from which IUD thread was observed: No thick fibrosis was observed around the site. Thus, we decided to remove IUD through mini-laparotomy: We held the thread and removed the IUD slowly, with no bleeding. Postoperative period was uneventful. Conclusion: In this case, considering no fibrosis around the perforated site, leaving                               this IUD potentially may cause future complications, and thus, we decided to remove it. No conclusion can be made from this single case, we believe that this case may provide information to decide whether perforated IUD, which was incidentally found, should be removed or not.