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________________________________
Daniel Braun
Sent: Tuesday, March 27, 2007 7:39 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Lost IUD
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
