2022 Volume 38 Issue 2 Pages 87-93
Levonorgestrel-intrauterine system (LNG-IUS) is mainly used for contraception. Recently, several studies reported cases in which an LNG-IUS partially perforated the uterine myometrium and migrated into the abdominal cavity. However, there have been no reports describing LNG-IUS migration from the myometrium into the abdominal cavity within a short period. Herein, we reported a laparoscopic removal of an LNG-IUS that migrated into the abdominal cavity within a short period.
Case: A 30-year-old woman (gravida, 3; para, 3) visited a clinic for LNG-IUS insertion for the purpose of contraception and improvement of dysmenorrhea at seven months postpartum. After five years, the doctor was unable to remove the LNG-IUS, and the patient was referred to our hospital. We attempted LNG-IUS removal under venous anesthesia, but it was unsuccessful. Ultrasound images showed LNG-IUS with partial myometrial perforation. We performed magnetic resonance imaging (MRI) after a 1-h procedure, and partial perforation was diagnosed. Two weeks later, we re-evaluated the MRI images because an abdominal computed tomography showed complete perforation. Upon the re-evaluation, we found that the previous MRI images actually showed complete perforation into the abdominal cavity. We thought that pulling the tail of the LNG-IUS in a state of partial perforation could lead to complete perforation due to uterine contraction. Under general anesthesia, the position of the LNG-IUS was determined on an abdominal X-ray. However, we successfully removed the LNG-IUS via laparoscopy.
Conclusion: Pulling the tail of an LNG-IUS in a state of partial perforation could lead to complete migration into the abdominal cavity. Abdominal X-ray tomography after induction of anesthesia was useful for determining the LNG-IUS location and facilitating its removal, laparoscopically.
