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Abstract
Uterine perforation remains the most serious complication of the intrauterine contraceptive
device (IUD). It is more common in the puerperium, usually occurring at the time of
insertion of a new device. Perforation may, however, also occur in the puerperium
if a pre-existing device is not removed in early pregnancy or extruded at the time
of delivery. The case is presented of a 30-year-old woman who became pregnant for
the third time following insertion of an IUD in the puerperium of her second pregnancy.
An uneventful pregnancy and delivery followed. Failure to detect the IUD at the time
of delivery led to laparoscopy and laparotomy to locate the device. A colotomy was
necessary to retrieve the device, which had formed a colocolic fistula. It is concluded
that the puerperium remains the time of greatest risk of uterine perforation by an
IUD. Although most occur at the time of insertion, this complication can also occur
with a previously inserted device. Severe intra-abdominal complications may ensue
if the device is not localized and removed. Laparotomy is justified if the laparoscopic
removal is unsuccessful. A high degree of suspicion is necessary if serious consequences
are to be avoided.
Keywords
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Article info
Publication history
Accepted:
August 15,
1997
Received in revised form:
August 15,
1997
Received:
June 20,
1997
Identification
Copyright
© 1997 Published by Elsevier Inc.
