Farkhanda Jabeen Dahri, Noor Muhammad Khaskheli.
Intrauterine Contraceptive device perforation.
J Coll Physicians Surg Pak Jan ;12(7):445-7.

Two cases of intrauterine contraceptive device (IUCD) perforation are reported here, which were presented in Surgical OPD at People`s Medical College Hospital, Nawabshah. Both the patients presented with vague abdominal pain and dysurea. On x-ray of abdomen, the IUCDs were found out of uterine cavity. Laparotomy was done in both the cases. In one case, copper `T` was removed from ileum and urinary bladder wall and repaired. In the other case, Lippes` loop was removed from omentum by omentectomy.

Case - I: A 26-year-old female, housewife reported in Surgical OPD with history of off and on pain in abdomen for the last one year. She complained of pain during micturation (dysurea) and off and on distention of abdomen for the same duration. She had had insertion of intrauterine contraceptive device (`Copper T`) by a lady health visitor about one year back during puerperium, at a family planning clinic. She became pregnant only two months after insertion. She therefore, went to some local doctor for checkup and had her x-ray abdomen, which showed displacement of `Copper T` from normal side. She was gravida 4, Para 2 + 2 and abortion nil. Her menstrual history was normal i.e. 4/28 days,. She had given birth to a full- term fetus about one month back. Her general, physical and systemic examinations were normal, the only finding was that she had tenderness in lower abdomen especially in the hypogastrium. The thread of intrauterine contraceptive device was not felt on digital per vaginal examination, which showed displacement of device from uterus. Her blood complete picture, blood sugar, blood urea and serum electrolytes were done, which were within normal limits. Her urine detailed report showed presence of 10 -12 pus cells per high power field. Her plain x-ray abdomen showed presence of intrauterine contraceptive device in pelvis but not in the normal position. It was lying transversely and there was a gas shadow around the T-loop. on the basis of the symptom it was decided to explore her. her laparotomy was, therefore, done by lower midline incision. Two loops of ileum were adherent to the fundus of urinary bladder, one of small limb of `Copper T` was in the wall of urinary bladder and the other small limb of `Copper T` was in the wall of an ileal loop. Long limb of `Copper T` was inside another loop of ileum. The `Copper T` was removed by enterostomy and intestine and urinary bladder was repaired.

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