PMC4671778_01
(A, B) Ectopic localization of the IUD by X-ray imaging.. Abbreviation: IUD, intrauterine device.
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After having been referred to the hospital, the X-ray examination of the pelvis was performed, revealing the presence of the insert outside the uterine cavity (Figure 1A and B).
Ultrasound imaging of the IUD.. Notes: (A) Ectopic localization of the IUD in ultrasound imaging (8 mm from the left common iliac artery). (B) Ectopic localization of the IUD in ultrasound imaging. The hypoechoic halo is visible. (C) Ectopic localization of the IUD in ultrasound imaging: increased vascularity around the foreign body is visible, particularly around the IUD ends.. Abbreviation: IUD, intrauterine device.
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In the ultrasound, the IUD was located above the left adnexal region, 8 mm from the left common iliac artery (Figure 2A). The hyperechoic structure (the insert containing barite and copper wire) in the hypoechoic halo was visible (Figure 2B), which suggested that the IUD was encysted. The Doppler ultrasound examination revealed the increased vascularity due to foreign body reaction, particularly around the IUD ends (Figure 2C), as a result of the tissue response to the presence of the device.
A piece of the IUD string (pointed with arrows) visible on the omental surface.. Abbreviation: IUD, intrauterine device.
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After insertion of the optical telescope and laparoscopic instruments into the peritoneal cavity, the device itself was not visible, but an ingrown piece of an IUD thread was found on the surface of the lower part of the omentum (Figure 3).
IUD embedded in the omentum.. Note: Encapsulation of the vertical arm of the IUD (pointed with arrow).. Abbreviation: IUD, intrauterine device.
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An attempt was made to remove the device by thread traction and then by traction of the isolated transverse arm of the insert (Figure 4). A cystic-like lesion surrounding the insert was also revealed (Figure 4).
Bipolar electroresection of the part of the omentum with the ingrown IUD.. Abbreviation: IUD, intrauterine device.
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Therefore, the ingrown device was removed by performing a resection of the part of the omentum with chronic inflammatory infiltration, by coagulation and cutting technique, using a bipolar forceps and scissors (Figure 5 and Figure 6).
Removal of the IUD from the abdominal cavity.
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Therefore, the ingrown device was removed by performing a resection of the part of the omentum with chronic inflammatory infiltration, by coagulation and cutting technique, using a bipolar forceps and scissors (Figure 5 and Figure 6).