Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.172
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
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.
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.
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.