Re: Lost IUD
From: Diana Saari MD (guto0002@tc.umn.edu)
Tue Mar 27 18:05:06 2007
My "N of 1":
Sweet multiparous Latina. IUD inserted 18 months prior at our County
hospital by one of my residents. Same - no strings; "lost". Pt felt
"accused" of not knowing that she spontaneously passed it; "I NEVER saw
it come out when I was having my period". Pt didn't know if it was a
Mirena or Paraguard, but thought it was to have been in for five years
at most. Now that I think about it I believe that it was found missing
at +UPT! [Resulted in SAB].
Called Mirena. They stated it should it should be seen on Abd XR.
Abd XR - negative.
Took her to scope for LLQ pain, and there it was, entangled in the
omentum in the LLQ. Called my partner to come and hold it for me and
extracted it easily. No complaints since.
So - there you go.
Reminds me of an attending who told me, "Tests are put on this earth to
confuse and mislead you".
I have the pictures if anyone wants to see them. It's spooky to see an
IUD in a very wrong place.
At Tue, 27 Mar 2007, R. Daniel Braun wrote:
>
>You beat me by 2 years, I inserted my first one in 1964 as an intern. It was
>a Birnberg Bow.
>
>Dan
>
>On 3/27/07, Atkinson, Samuel M <ATKINSONS@ecu.edu> wrote:
>>
>> If you don't see it with ultrasound then it is likely in the sewer
>> system. If it was still in the uterus she would in all likelihood be
>> having scant or no menses. Using the withdrawal technique for insertion
>> of Mirena makes it highly unlikely that a perforation has occurred and
>> even less likely to be intraperitoneal. I would deplore anything except
>> a flat plate. If it isn't there it ain't there. An intraperitoneal
>> insertion of a Mirena is somewhat unprecedented. Spontaneous passage in
>> a menstrual clot is common. As an aside, copper IUD's are highly
>> inflammatory in the peritoneal cavity and adhere to most everything.
>> Removal with a laparoscope is difficult and laparotomy is usually
>> required. Copper IUD's should be removed. There is debate as to whether
>> a Mirena even needs to be removed if in the peritoneal cavity as it has
>> no copper. The minute amount of progesterone secretion in the abdomen
>> would not prevent pregnancy nor affect it.
>> PS: I inserted my first IUD's in 1962. My latest was two weeks ago (a
>> Mirena). My only publications were about the Dalkon Shield and I
>> testified in numerous class action claims about it.
>> sAm
>>
>> -----Original Message-----
>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry
>> E. Siegel, M.D.
>> Sent: Monday, March 26, 2007 7:17 PM
>> To: Multiple recipients of list OB-GYN-L
>> Subject: Gyn: Lost IUD
>>
>> 25 YO P1001 with a Mirena of around one year's duration, came in for
>> removal. No string seen, and on exploring the uterus with an IUD hook,
>> well, no IUD found.
>>
>> Ultrasound did NOT find her IUD, so it is lost.
>>
>> I have recommended H-scope/lapscope to find it, but she has asked about
>> having a CT first. Actually, I hadn't thought of that, and it seems
>> that a plain X-ray may be even the better first choice.
>>
>> My real questions is: Is there any role for imaging? My instinct says we
>> simply need to go to the OR, as she couldn't have expelled it and not
>> known it, I wouldn't think. That said, if it is up under her diaphagm.
>> . .
>>
>> Garry
>>
>> --
>> Garry E. Siegel, M.D.
>> Private Practice
>> Roswell, GA
>>
>--
>R. Daniel Braun, MD FACOG(L) CMT
>Professor Emeritus
>Dept. of Obstetrics and Gynecology
>Indiana U. School of Medicine
>
>R. Daniel Braun
>
> "The way to health is an aromatic bath and scented massage everyday".
> Hippocrates
>
--
Diana Saari MD FACOG
guto0002@tc.umn.edu
University Specialists in Women's Health
Minneapolis, MN
