{
    "abstract": "Rates of perforation for different types of IUDs vary from 1 per 150 insertions with the bow to 1 per 2500 with the loop. Incidence of perforation varies with insertion technic. Not all perforations occur at the time of insertion but most do. These perforations may be partial or complete, with or without symptoms, and complications range from mild anxiety to life-threatening situations. With the older closed-loop devices intestinal strangulation was a threat. Partial perforations have been identified as sources of intestinal volvulus and septic abortions. With the increase use of IUDs and the increased frequency of perforations, a technic simpler than laparotomy was desired to remove intraperitoneal devices. Laparoscopy seems safer and is associated with fewer side effects than laparotomy. Before attempting removal, the patient is examined to determine if the string attached to the IUD can be seen. In 18% of women with retracted strings perforation is present. The uterus is probed to detect the IUD. A plain x-ray of the abdomen is taken to rule out unnoticed expulsion. If the x-ray reveals the IUD, a hysterosalpingogram is performed with both autero-posterior and lateral views using 40% iodized oil. Laparoscopy is performed under general anesthesia with the patient in the lithotomy position. The uterus is manipulated by a tenaculum on the cervix. The abdomen is distended with gas, 3-4.5 liters. The patient is then slowly moved into the Trendelenburg position to allow the omentum and intestines to withdraw from the pelvis. When the IUD is found, it can be grasped by Eder tongs and withdrawn. Lippes Loops were removed from 5 patients by this method. All recovered uneventfully. Left lower quadrant pain was the only symptom complained of before the operation. 1 patient had been pregnant and after a successful delivery the extrauterine IUD was removed 1 day postpartum. Laparoscopy produces minimal surgical trauma, the postoperative course is short, and morbidity has not been encountered. Tubal coagulation could be done at the same time if desired.",
    "authors": [
        {
            "affiliation": null,
            "firstname": "J R",
            "initials": "JR",
            "lastname": "Allen"
        },
        {
            "affiliation": null,
            "firstname": "R E",
            "initials": "RE",
            "lastname": "Shemwell"
        },
        {
            "affiliation": null,
            "firstname": "D P",
            "initials": "DP",
            "lastname": "Macleod"
        },
        {
            "affiliation": null,
            "firstname": "J C",
            "initials": "JC",
            "lastname": "Weed"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": null,
    "journal": "Obstetrics and gynecology",
    "keywords": [
        "Clinical Research",
        "Contraception",
        "Contraception Termination",
        "Contraceptive Methods--complications",
        "Diseases",
        "Family Planning",
        "Insertion",
        "Iud, Unmedicated",
        "Iud--complications",
        "Perforations",
        "Research Methodology",
        "Uterine Perforation"
    ],
    "methods": null,
    "publication_date": "1972-08-01",
    "pubmed_id": "4261740",
    "results": null,
    "title": "Removal of intrauterine contraceptive devices after uterine perforation.",
    "xml": "<Element 'PubmedArticle' at 0x788504588310>"
}