Zhang GR, Yu X. Perforation of levonorgestrel-releasing intrauterine system found at one month after insertion: A case report. World J Clin Cases 2023; 11(1): 172-176 [PMID: 36687185 DOI: 10.12998/wjcc.v11.i1.172]
Corresponding Author of This Article
Xin Yu, MD, Professor, Department of Obstetrics and Gynecology, State Key Laboratory of Complex, Severe and Rare Diseases, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Beijing 100730, China. yuxpumch@126.com
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 6, 2023; 11(1): 172-176 Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.172
Perforation of levonorgestrel-releasing intrauterine system found at one month after insertion: A case report
Guo-Rui Zhang, Xin Yu
Guo-Rui Zhang, Xin Yu, Department of Obstetrics and Gynecology, State Key Laboratory of Complex, Severe and Rare Diseases, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Zhang GR collected the data, imaging, and surgical reports and wrote the initial draft of the manuscript and subsequent revisions; Yu X is the senior author who was the treating surgeon and was responsible for overseeing the report and editing the manuscript; both authors read and approved the final manuscript.
Supported byNational High Level Hospital Clinical Research Funding, No. 2022-PUMCH-A-232
Informed consent statement: The patient provided informed consent as evidenced by her signature.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised following the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin Yu, MD, Professor, Department of Obstetrics and Gynecology, State Key Laboratory of Complex, Severe and Rare Diseases, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Beijing 100730, China. yuxpumch@126.com
Received: August 30, 2022 Peer-review started: August 30, 2022 First decision: November 22, 2022 Revised: December 3, 2022 Accepted: December 19, 2022 Article in press: December 19, 2022 Published online: January 6, 2023 Processing time: 127 Days and 10.8 Hours
Abstract
BACKGROUND
The levonorgestrel-releasing intrauterine system (LNG-IUS) is widely used in contraception, menorrhagia, dysmenorrhea and to prevent endometrial hyperplasia during estrogen supplementation. Perforation is more often seen after early postpartum placement. Perforation of the LNG-IUS occurring one month after placement is rare.
CASE SUMMARY
A 42-year-old female complained of progressive dysmenorrhea and increased menstrual volume. She was diagnosed with adenomyosis and the LNG-IUS was inserted in her uterine cavity. Routine ultrasound examination one month later revealed that the intra-uterine device (IUD) was not found in the uterine cavity, and further X-ray and pelvic magnetic resonance imaging showed an abnormal signal area in the left posterior region of the uterus. Laparoscopic exploratory surgery was performed and the LNG-IUS was found in the left uterosacral ligament.
CONCLUSION
Perforation of a LNG-IUS occurring one month after placement is rare, and is more common in inexperienced operators and after early postpartum placement. When the operation is difficult, ultrasound monitoring is recommended to reduce the risk of IUD perforation. For patients with inadequate surgery, postoperative imaging is recommended to detect potential risks as soon as possible.
Core Tip: Perforation of a levonorgestrel-releasing intrauterine system occurring one month after placement is rare. We report a patient who underwent levonorgestrel-releasing intrauterine system placement due to adenomyosis, and perforation was found one month later. Perforation is more common in inexperienced operators and after early postpartum placement. When the operation is difficult, ultrasound monitoring is recommended to reduce the risk of intra-uterine device perforation. Postoperative imaging is recommended to detect potential risks as soon as possible.
