レボノルゲストレル放出子宮内システムが短時間で子宮筋層内から腹腔内へ迷入し、腹腔鏡下手術で安全に回収した１例

抄録

　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.