Uterine perforation

Uterine perforation is aserious problem which can occur after intrauterine device (IUD) insertion. Migration of IUD to the pelvic and abdominal cavity or adjacent organs may follow the perforation of the uterus. Migration to a far intra-abdominal site is extremely rare. The patient reported here had 2 years history of IUD placement and had slight gastrointestinal problems during this period. She got pregnant despite an IUD. The IUD was incidentally seen in sigmoid colon mesentery at the secarean section and than referred to us. This paper presents a case of a 32-year old woman with a copper IUD in the sigmoid colon mesentery noticed during her caesarean section. In this report, clinical presentation and management of this condition were discussed with the literature knowledge.

Intrauterine device (IUD) is a common contraceptive method, due to its cost-effectiveness and low complication rates. Uterine perforation is a possible complication and IUD migration to the bladder is a rare and morbid condition. The present report describes an interesting case in which the urinary manifestations started 13 years after insertion, and the main clinical finding was exercise-induced hematuria.

PurposeWe aimed to evaluate the pregnancy characteristics and obstetric outcomes in patients after perforation of the uterus. Study design: A retrospective cohort study was conducted and included all patients who were diagnosed with uterine perforation and treated in a tertiary referral medical center between the years 1996 and 2018. Up to two deliveries after perforations were investigated. Results: During the study period, 51 women were diagnosed with uterine perforation during gynecological procedures, including intrauterine device (IUD) insertion. The mean age of patients at the time of diagnosis was 27.9 (±4.7) years. The majority, 76.5% (n = 39), experienced perforation during IUD insertion, and 23.5% (n = 12) of the patients experienced perforation during surgical procedures. Most of the patients were multiparous or grand multiparous, 45.8. % (n = 22) and 39.6% (n = 19) respectively. Anteflexed uterus was found in 86.4% of the patients (n = 38). Five patients (9.8%) had pelvic abscesses after the IUD insertion. A total of 50 patients had 71 deliveries subsequent to uterine perforation. One patient experienced intrauterine fetal death due to fetal malformations. One patient experienced uterine rupture. No other major obstetric complications were noted. Conclusions: Uterine perforation may be associated with adverse obstetric outcomes. The possibility of uterine rupture must be considered while managing the deliveries of patients after uterine perforation. Moreover, a larger cohort and further studies are needed to establish an association between uterine perforation and adverse outcomes of the subsequent deliveries.

A 27-year-old woman, fourth gravida, with three prior consecutive vesicular moles was diagnosed with a recurrent vesicular mole on ultrasonography (USG) and had very low β-human chorionic gonadotropin (HCG) values. During suction evacuation no vesicles were seen and on repeat USG the patient was diagnosed to have fibroid uterus. She was discharged at request and advised to undergo MRI to rule out choriocarcinoma. The MRI was interpreted as fibroid uterus with degeneration. After 3 weeks of suction evacuation, the patient presented with acute abdomen. She underwent emergency laparotomy for haemoperitoneum and was diagnosed as invasive mole with perforation; total hysterectomy was performed. Her β-HCG after laparotomy was more than 200 000 mIU/L, and the histopathological examination revealed choriocarcinoma. When methotrxate, adriamycin and cyclophosphamide (MAC) therapy was advised, the patient initially received methotrexate monotherapy; after three cycles her β-HCG started rising after an initial drop, and the patient required four cycles of EMACO to achieve remission.

Objectives: To assess knowledge and attitude regarding PPIUCD among antenatal mothers and relationship between knowledge and attitude. To determine association between knowledge and selected background factors and association between attitude and selected background factors.

Intrauterine devices (IUDs) are commonly used as a contraceptive method. However, they may cause rare but potentially serious complications such as migration through the uterine wall and gastrointestinal perforation. We report a case of a 26-year woman, carrying an IUD for 2 years, who presented to the emergency with pelvic pain with breakthrough bleeding. Abdominal imaging revealed the presence of two devices the first of which was located in the uterine cavity and the other in the wall of the sigmoid colon associated with a 5-centimeter pelvic collection. Intraoperatively, the IUD was found to be embedded in the wall of the sigmoid colon which was removed by wedge resection of the involved segment followed by a closure of the puncture with drainage. The Intrauterine Device (IUD) is an effective method of contraception, relatively well tolerated, reversible, inexpensive and widely used. However, it is not without risk. Indeed, serious complications can occur such as uterine perfora...

Intrauterine contraception is a widely used, highly effective method of birth control. Uterine perforation is a serious albeit rare complication with the use of an intrauterine device (IUD). Although uterine perforation by the levonorgestrel-releasing intrauterine system (LNG-IUS) has already been described, no plasma LNG concentrations in this setting were reported. Neither has the management of LNG-IUS been commented on to date. Two months after insertion of an LNG-IUS into a 33-year-old woman, it was noted to be in the peritoneal cavity. Laparoscopy for IUD removal was conducted 5 months after insertion. LNG and sex hormone-binding globulin plasma concentrations were measured prior to and following the laparoscopic removal of the IUD. Intra-peritoneal dislocated LNG-IUS resulted in plasma LNG levels 10 times higher (4.7 nmol/l) than the plasma level of LNG observed with LNG-IUS placed in utero. This high plasma LNG level suppresses ovulation. Therefore a misplaced LNG-IUS should be removed when pregnancy is desired.

Choriocarcinoma is the most malignant tumor of gestational trophoblastic neoplasia. Choriocarcinoma presenting as postpartum hemorrhage and spontaneous uterine perforation with intra-abdominal hemorrhage is very rare. We present a 29-year-old woman with spontaneous uterine rupture due to choriocarcinoma following a live birth pregnancy. The long time interval (2 years) between the previous live birth pregnancy and the diagnosis of the disease, the acute onset of the disease by uterine rupture as the Wrst symptom and the negative urine hCG test are presented and discussed in this case report.

OBJECTIVE: To estimate the effect of length of contraceptive use on anti-Mullerian hormone (AMH) levels in reproductive-age women. DESIGN: Prospective analysis of serum AMH levels and survey data. MATERIALS AND METHODS: The study included a subset of customers who used an at-home fertility hormone test between June 2018 and April 2020 (n ¼ 2,358). Participants were between 21 and 46, consented to research, had not reported a previous diagnosis of polycystic ovary syndrome or primary ovarian insufficiency, and were currently using either the levonorgestrel IUD (LNG-IUD), implant, combined oral contraceptive (COC), or vaginal ring. The duration of contraceptive use was self-reported and ranged from 1-3 months up to more than 20 years. We performed three linear regressions per contraceptive method to evaluate the relationship between the length of contraceptive use and log-transformed AMH levels. Since three regressions were run per contraceptive group, the threshold for statistical significance (a ¼ 0.05) was set to 0.017 to adjust for multiple comparisons. We subsequently grouped short-term use and long-term use participants into binary categories or bins and compared mean AMH levels for each contraceptive use group. RESULTS: Our cohort included 807 women using the LNG-IUD, 112 using the implant, 1,109 using a COC, and 165 using the vaginal ring. There were no statistically significant associations between length of contraceptive use and adjusted AMH levels for any contraceptive method. This was true in regressions of the entire sample and when we limited the sample to just shortterm users or just long-term users. When the length of contraceptive use was treated as a binary variable (short-term <1 year or long-term 1+ years) or was grouped into categories spanning approximately 5 years, no statistically significant effects were observed for any contraceptive method. CONCLUSIONS: It is known that AMH levels are lower in women using hormonal contraceptives when compared to women who aren't. However, this study shows that the duration of contraceptive use is not associated with any additional variation in AMH levels. We observe no impact of either long or short term usage on AMH levels for any of the contraceptive methods included in this study. These results are reassuring since it is still widely believed among physicians and patients alike that long term contraceptive use suppresses ovarian reserve more than short term use, particularly in users of COC. Women are increasingly seeking testing of their ovarian reserve while remaining on contraceptives to prevent pregnancy. Reasons for getting tested for AMH while on contraceptives are varied and include seeking proactive hormone assessments, getting information about time to menopause, egg freezing, or donating eggs. Having to stop contraception to test ovarian reserve may be unwanted or inconvenient. By better understanding the effects of contraceptives on AMH, women will have more options when pursuing this testing, and physicians will be better equipped to interpret the results.

underlying mechanisms of association might better be gleaned from qualitative data. Methods: We conducted qualitative in-depth interviews with a diverse group of women (N=49) visiting low-cost family planning or mental health clinics in the Washington, D.C. area. Interviews focused on women's mental health histories and experiences, current depressive symptoms (PHQ, BDI-II), feelings about parenthood and having children, and contraceptive behaviors. We used grounded theory techniques to code the data in three waves using Dedoose software. Results: Overall, depressed and non-depressed women shared many attitudes on having children, including the importance of mental preparedness, financial stability, and partner support. However, women with depression (moderate to severe symptoms or a depression diagnosis) overwhelmingly wanted to delay childbearing or were ambivalent about having children. They cited concerns regarding not being a good parent, not being worthy of parenthood, passing mental health issues to their offspring, and taking medication while pregnant. Women with depression also cited more instances of unprotected sex, compared to non-depressed women. Conclusions: Our results indicate that women with depression think deeply about how their mental health might impact their potential children and parenting role, and this shapes their fertility desires accordingly. However, their fertility desires frequently appear to be misaligned with their contraceptive behaviors. Implications for how family planning and mental health services can be better integrated to serve women with depression will be discussed.

Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01e0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6%. We report an original case report of an unusual presentation of carcinoma cervix presenting as acute peritonitis. Spontaneous rupture of carcinoma cervix associated pyometra resulting in peritonitis is an extremely rare complication with only 7 cases reported till date including the present case is reviewed.

Use of the intrauterine device (IUD) is widely accepted as a contraceptive method throughout the world because of its safety, economy, efficiency, and reversibility. However, IUD use is associated with rare side effects and complications, such as irregular menstrual bleeding, dysmenorrhea, pelvic infections, expulsion of the device, and uterine perforation. Uterine perforation is a rare but serious complication that generally occurs during insertion of the device, but may also occur as a result of migration of the IUD through the uterine wall. Expulsion and dislocation of the IUD may lead to pregnancy; however, pregnancy can still occur even when the IUD remains in utero, and its efficacy has been demonstrated to be about 97% . Displaced IUDs are associated with potential risks to the adjacent organs, such as the bowel or bladder, and might also lead to pelvic infections and abscesses. The management of extrauterine displaced IUDs still remains controversial, and no consensus opinion exists. In this case report, a patient presented with an undesired pregnancy and a displaced IUD, which was located within a pelvic abscess in the Douglas pouch. The management of extrauterine displaced IUDs is also discussed. A 28-year-old woman had an undesired pregnancy with a displaced IUD, which was found within a pelvic abscess in the Douglas pouch. She was referred to our clinic, complaining of pelvic pain, fever, fatigue, nausea, vomiting and missed menstrual period. She had a history of IUD insertion 4 years ago and no history of previous pelvic inflammatory disease or sexually transmitted disease. Her menstrual periods were regular. Her inflammation markers were as follows: C-reactive protein was 50 mg/L, and leukocyte count was 15,000/μL.

Use of the intrauterine device (IUD) is widely accepted as a contraceptive method throughout the world because of its safety, economy, efficiency, and reversibility. However, IUD use is associated with rare side effects and complications, such as irregular menstrual bleeding, dysmenorrhea, pelvic infections, expulsion of the device, and uterine perforation. Uterine perforation is a rare but serious complication that generally occurs during insertion of the device, but may also occur as a result of migration of the IUD through the uterine wall. Expulsion and dislocation of the IUD may lead to pregnancy; however, pregnancy can still occur even when the IUD remains in utero, and its efficacy has been demonstrated to be about 97% . Displaced IUDs are associated with potential risks to the adjacent organs, such as the bowel or bladder, and might also lead to pelvic infections and abscesses. The management of extrauterine displaced IUDs still remains controversial, and no consensus opinion exists. In this case report, a patient presented with an undesired pregnancy and a displaced IUD, which was located within a pelvic abscess in the Douglas pouch. The management of extrauterine displaced IUDs is also discussed. A 28-year-old woman had an undesired pregnancy with a displaced IUD, which was found within a pelvic abscess in the Douglas pouch. She was referred to our clinic, complaining of pelvic pain, fever, fatigue, nausea, vomiting and missed menstrual period. She had a history of IUD insertion 4 years ago and no history of previous pelvic inflammatory disease or sexually transmitted disease. Her menstrual periods were regular. Her inflammation markers were as follows: C-reactive protein was 50 mg/L, and leukocyte count was 15,000/μL.

Funding for this research was provided by Bayer AG, Berlin, Gennany to RTI Health Solutions (RTI-HS), Kaiser Pennanente No1thern California (KPNC), Kaiser Pe1manente Southern California (KPSC), Kaiser Pe1manente Washington (KPWA), and Regenstrief Institute (RI). RTI-HS led the study design and conducted analyses with review and interpretation of results in collaboration with KPNC, KPSC, KPW A, RI, and Bayer AG. The contracts between Bayer AG and each of the other organizations (KPNC, KPSC, KPWA, RI, RTI-HS) include independent publication rights Bayer AG was provided the oppo1tunity to review the manuscript prior to submission and comments were adviso1y only. MSA, DG, MJF,

Uterine perforation is a rare complication of abortion. It becomes much rarer when associated with a small bowel incarceration at the uterine breach. Its diagnosis can be suspected clinically, but radiology remains more sensitive for diagnosis. Surgery is the cornerstone in treating this entity as it provides both diagnostic and therapeutic management. A multidisciplinary therapeutic approach should be immediately performed to ensure a good prognosis. In this report, we describe a case of small intestine incarceration in the breach of a uterine perforation that occurred in the weeks following a clandestine abortion.

Background: Misplacement is one of the complications reported with intrauterine devices (IUCDs) as a form of contraception. Objective: To study the methods of diagnosis and mode of management of misplaced IUCDs at the Federal Teaching Hospital, Ido-Ekiti. Methods: This is a retrospective review of records of all clients who presented with complaints of missing IUCD over a 5 year period, from 1st January 2011 t0 31st December 2015. Results: A total of 527 clients were seen at eth family planning unit within the period under review. Three hundred and one (301) clients used IUCD, giving a prevalence of 57.1% of total contraceptive use. Of these, 12 IUCDs were reported misplaced, giving the incidence of misplaced IUCD as 4%. The peak age of the clients reporting misplaced IUCD was 31-40years.  IUCDs insertion during puerperium was seen in 33.4% while most most (41.6%) had their IUCD insertion more than 12 months followings last childbirth. When considering IUCD insertion in relation to abortion and menses, most (50%) had insertion during menstrual period, 25% had insertion just before the onset of the next menses, postabortal insertion was seen in 16.7% while one (8.3%) could not ascertained the event that preceded the insertion of IUCD. Inability to feel the thread was the commonest presenting complaint in 6 (50%). Most of the clients with misplaced IUCD had the device inserted at the primary health centre (41.6%) and private hospital (33.4%). Pelvic examination with uterine sound and abdominal ultrasound were the diagnostic methods commonly used. Most clients (83.3%) missed their IUCDs within the first twelve months of use. Retrieval hook was used for removal in 91.7% of the cases. One (8.3%) had exploratory laparatomy to recover the missing IUCD. Conclusion: Intrauterine devices should be inserted after proper case selection by properly trained medical personnel in both primary and tertiary centres in order to reduce reported cases of missing IUCDs.
Keywords: Intrauterine Contraceptive Device, misplacement, diagnosis, management

OBJECTIVE: To investigate the effect of second uterine curettage on the number of chemotherapy courses and relapse rate in low-risk postmolar gestational trophoblastic neoplasia. METHODS: In a phase III trial, patients with low risk gestational trophoblastic neoplasia were randomised (1:1) to a second curettage or no curettage group before methotrexate treatment. Eligibility criteria were serum human chorionic gonadotropin (hCG) level 5,000 international units/L or less and fit for treatment with methotrexate. Exclusion criteria were previous uterine perforation and life-threatening bleeding. With a two-sided 5% significance level and a power of 99%, a sample size of 44 patients per group was necessary to detect a mean reduction in 2.3 chemotherapy courses. The primary outcome was the number of chemotherapy courses required for hCG normalization. Secondary outcomes were needed for second-line treatment, toxicity, relapse rates, and variables associated with number of chemotherapy co...

Small bowel perforation is a unique, serious complication during endometrial biopsy. The authors report a case of a double uterine-ileal perforation totally managed by primary laparoscopic repair. A 63-year-old female was admitted with acute abdomen 2 days after an endometrial curettage. Abdominal X-ray shows signs of pneumoperitoneum. Emergency diagnostic laparoscopy was performed and a uterine-ileal perforation was identified. Repair was accomplished by a totally laparoscopic intracorporeally suturing of the 2 breaches. Postoperative course showed only a delayed ileus and the patient was discharged after 5 days with no complications. When acute abdomen arises following uterine biopsy, a potential iatrogenic intestinal laceration always has to be ruled out. Laparoscopic approach is a quick and safe technique in these cases. Totally laparoscopic primary closure of the iatrogenic ileal laceration may be accomplished with low morbidity.

The intrauterine device is a popular and highly effective form of long-acting reversible contraception. Although generally safe, complications could happen. One of the most serious complications of intrauterine device use is uterine perforation. Risk factors for perforation include, but are not limited to, postpartum period, breastfeeding, levels of experience, and excessive force exerted during insertion. This case is significant because it demonstrates risk factors for uterine perforation, how to handle missing strings, and care in places with little resources. Case Presentation: We discuss the case of a 27-year-old black Ethiopian woman who presented with chronic pelvic pain and had a perforated intrauterine device discovered in the cul-de-sac. The device had been inserted at six weeks postpartum. The client was unable to feel the strings three months after insertion, and a wrong diagnosis of expulsion was made. After one year of insertion, the intrauterine device was located on a plain abdominal radiograph and removed via laparotomy without complications. Conclusion: Although uterine perforation is a rare complication of intrauterine device insertion, special attention should be paid to women with risk factors. In the absence of a witnessed expulsion, assessments and investigations should be carried out before declaring a device expelled. In patients with chronic pelvic pain complaints in the presence of an intrauterine device, perforation and migration outside the uterine cavity should be considered. Abdominal X-rays and laparotomies can be used to find and manage extrauterine migrating devices in environments with limited resources.

Background: The extrauterine migration of an intrauterine device (IUD) can be life threatening and require emergent surgical intervention and treatment. Migration is usually the result of IUD expulsion or uterine perforation. Objective: This case report describes a presentation of extrauterine migration of an IUD due to probable perforation. Case Report: This is a case report of an uncommon but potentially dangerous outcome of IUD placement and use. The potential migration of an IUD and resultant uterine perforation must be considered in the differential diagnosis of any woman using this type of contraception who presents with abdominal pain. This report is unique due to the subtle presentation of a potentially lifethreatening diagnosis. Conclusion: This article presents the case, discusses the incidence, potential causes, predisposing factors, diagnostic modalities, and the course of treatment for this particular diagnosis.

Uterine perforation is a rare life threatening complication due to unsafe abortion by unqualified or untrained person. CASE: A 20 year old primigravida with 6 months ANC was referred to our hospital with the USG of uterine rupture and with a history of Dilation and curettage i/v/o anomalous baby, was in septic shock. There was also evidence of Sigmoid colon perforation. As a life saving measure Obstetric hysterectomy with colostomy done. Unsafe CONCLUSION: abortions are still in practice which has led to increased rate of mortality and morbidity. surgical intervention on a uterus of more than 20 weeks can be hazardous and should be terminated wisely.

Background: Uterine rupture following choriocarcinoma is rare and this can increase morbidity and mortality in a condition that has over 90% curative rate. This was the first case of uterine rupture and intestinal metastasis resulting from choriocarcinoma that was managed in our facility. Case Presentation: A 29-yearold P 0 + 1 lady who presented at our facility on 21/3/2019, with abdominal pain, distension and ultrasound report suggestive of molar pregnancy. Her last menstrual period was on 18/2/2019. She had a history of spontaneous miscarriage about four months prior to presentation. Quantitative beta-human chorionic gonadotropin (B-HCG) was 131,106.17miu/ml and chest x-ray revealed multiple intrapulmonary masses most probably metastatic lung disease. She was scheduled for suction evacuation, but further evaluation revealed signs of haemoperitonium necessitating exploratory laparotomy with finding of extensive molar uterine invasion, ragged uterine rupture and dilated 180 0 twisted small intestinal loops containing blood with areas of mesenteric ischaemia and friable seedlings on the ileum serosa that adhered to the uterus. A total abdominal hysterectomy and mesenteric untwisting were done. She received 6 courses of chemotherapy with Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Oncovin (EMACO) regimen due to high-risk prognostic score of 8. The qB-hCG normalized after the 3 rd course of chemotherapy. She had been followed up with monthly qB-hCG for one year with no recurrence. Conclusions: This is to emphasize the need for histology of products of conception following miscarriages. It is also pertinent for any woman within the reproductive age presenting with bleeding to have at least one B-hCG assay to ensure that metastatic gestational trophoblastic neoplasia is excluded.

The uterine rupture during pregnancy is a catastrophic condition resulting in both maternal and perinatal morbidity and mortality. It occurs in nearly 1% of patients with previous cesarean sections. However, uterine rupture at the site of previous iatrogenic perforation which is spontaneously healed or repaired is less reported. We present a 29-year-old woman, gravida 3 para 1, at 20 weeks of gestation with abdominal pain of right half and hemodynamic instability whose laboratory evaluations revealed severe acute blood loss but still without any signs of peritonitis. The exploratory laparotomy revealed a uterine rupture at the site of fundus at the same location of previously repaired dilatation and curettage-induced perforation contributing to extrusion of whole pregnancy product in addition to severe intra-abdominal blood loss.

Intrauterine devices are a very eVective form of contraception used worldwide for more than 2 centuries. One of the serious, but rare, complications of intrauterine contraception is perforation through the uterine wall into the pelvic or abdominal cavity. In this report we describe, persistent periumbilical discharge associated actinomycosis caused by migration of a copper intrauterine contraceptive device. To our knowledge, this is the Wrst report of persistent periumbilical discharge caused by migration of a copper intrauterine contraceptive device. We recommend consideration of this minor possibility during evaluation of women with chronic abdominal discharge.

Intestinal injury following uterine perforation is a serious complication of intrauterine device (IUD) application. It can be in the form of obstruction, perforation or ischemia leading to stricture or fistulae formation. Perforation commonly involves sigmoid colon followed by the small intestine and rectum. Acute complications like peritonitis may occur sometimes leading to death. These complications commonly occur during insertion. Very rarely it may occur during the IUD removal. We are reporting an unusual case of small intestinal (ileum) injury during IUD removal leading to peritonitis.

To show the removal of an intramyometrial fetus after uterine curettage using Laparoscopy, as a safe surgical technique that offers excellent results and fewer complications than Laparotomy DESIGN: Presentation of the clinical case and step-by-step explanation of the technique. Uterine curettage is a frequently performed gynecological abortion procedure. Dilatation and curettage is considered as a safe surgical technique, with low percentage of complications. The most common is uterine perforation, with higher risk in advanced gestational age, retroflexed uterus or uterine leiomyomas. After IRB approval, we present the case of a 29 year-old female was referred to our hospital from another clinic with a suspected uterine perforation after an elective curettage for a 14-week pregnancy. She presented just moderate abdominal pain. Vaginal ultrasound revealed intramyometrial foetal parts on isthmus and right parametrium, and minimal free fluid in the pouch of Douglas. A laparoscopic appr...

We report a case of compound segmental comminuted fracture of the Left clavicle, fracture of second rib, comminuted fracture of scapula with subclavian vein laceration and perforation of the parietal pleura and lung contusion that caused massive haemo-pneumothorax. Emergency exploration followed by repair of subclavian vein, pleura and fixation of clavicle were able to salvage the patient.

An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingo-oophorectomy for uterine perforation because of repeated dilatation and curettagefor persisting vaginal bleeding following molar evacuation.As significant proportion of molar do progress into Gestational trophoblastic Neoplasiawhich in this case was choriocarcinoma; directs our attention to the fact that properfollow up of post molar cases using at least urinary beta HCG and institutingchemotherapy whenever necessary should be advocated in order to avoid such adrastic management.Key Words: Uterine perforation, molar, Gestational Trophoblastic Neoplasia (GTN)

Uterine perforation followed by transmigration of intrauterine contraceptive device to the abdominal cavity is one of the rarest, but most dangerous complication of Copper T. These displaced Copper containing devices can cause chronic inflammatory reaction leading to adhesions, intestinal obstruction and even bowel perforation. Hence removal of these devices once found outside the uterus is recommended. Traditionally, a laparotomy used to be performed owing to the associated inflammation, adhesions and the risks of bowel injury. Laparoscopic removal of these displaced devices is a minimally invasive surgical approach with good results in skilled hands. Authors reported a rare case of misplaced transmigrated intrauterine contraceptive device in a 43-year-old asymptomatic lady. The Copper T had migrated after silent perforation of the uterus and was impacted in the greater omentum. There was evidence of chronic inflammation and small pockets of pus surrounding it. There were flimsy bo...

This section is suitable for reporting results of therapeutic trials, descriptions of new procedures or instruments, and case reports which illustrate a principle. Reports should be limited to seven hundred words and two references. Use of an illustration or table requires a proportionate reduction in total words.

Uterine perforation is a serious complication after insertion of an intrauterine device (IUD). We report the case of a 34-year-old woman receiving in consultation for abdominal pain. In the interrogation there was a notion of IUD insertion for about a week. The gynecological examination did not find the thread of IUD and the ultrasound performed did not visualize an IUD. Radiography of the abdomen without preparation highlighted a compatible intrapelvic foreign thing like an IUD. The diagnosis of pelvic inflammatory disease by uterine perforation by an IUD was thus retained. We suggest in case of suspicion of uterine radio paque IUD perforation achieving radiography when the abdominal pelvic ultrasound is normal.

Uterine perforation is the most serious complication associated with an intrauterine contraceptive device (IUD). Minimally invasive techniques, such as hysteroscopy and advanced laparoscopy, are ideally suited to the diagnosis and surgical management of the perforated IUD. Three cases of uterine perforation caused by an IUD and treated with endoscopic surgery are presented. In all 3 cases, the IUD was located by using x-rays, ultrasonography, or pelvic magnetic resonance imaging. Diagnostic laparoscopy was performed to identify the specific location of the IUD and to remove it. All patients recovered without incident. The gynecologic surgeon should acquire familiarity with the complications of, and proficiency in managing, perforated and ectopic IUDs by using modern surgical techniques that permit the patient&#39;s rapid return to health.

Background: Acute abdominal pain is a very common presenting complaint in the Emergency Department (ED). Making the correct diagnosis may be very complicated and difficult. It is even more difficult and complicated in the postpartum period, because other less common but important diagnoses must be considered. One of these potentially lifethreatening diagnoses for which patients should be evaluated is uterine rupture. Objectives: To discuss uncommon, but important, causes of abdominal pain that may occur in the postpartum period. To learn the clinical presentation, risk factors, evaluation, and management of uterine rupture in the postpartum patient. Case Report: We present the case of a 36-year-old woman who presented to the ED with 2 days of abdominal pain and fever. The patient had had a caesarian section (C-section) 2 weeks before this admission. This was her fourth C-section. On examination, she had right lower quadrant tenderness. A computed tomography scan of the abdomen with contrast was obtained and it revealed uterine perforation with an adjacent abscess. The patient received intravenous fluids and broad-spectrum antibiotics. A laparotomy was performed that confirmed the diagnosis of uterine perforation. The patient subsequently did very well. Conclusions: Uterine perforation should be considered in any postpartum patient that presents with acute abdominal pain, especially if there are risk factors, such as previous C-sections. Appropriate evaluation, consultations, and management should be done expeditiously to avoid increased morbidity and mortality.

We report a case of compound segmental comminuted fracture of the Left clavicle, fracture of second rib, comminuted fracture of scapula with subclavian vein laceration and perforation of the parietal pleura and lung contusion that caused massive haemo-pneumothorax. Emergency exploration followed by repair of subclavian vein, pleura and fixation of clavicle were able to salvage the patient.