Maebayashi A, Kato K, Hayashi N, Nagaishi M, Kawana K. Importance of abdominal X-ray to confirm the position of levonorgestrel-releasing intrauterine system: A case report. World J Clin Cases 2022; 10(15): 4904-4910 [PMID: 35801018 DOI: 10.12998/wjcc.v10.i15.4904]
Corresponding Author of This Article
Aki Maebayashi, MD, Doctor, Obstetrics and Gynecology, Nihon University Hospital, 1-6 Kanda Surugadai, Tokyo 1018309, Japan. maebayashi.aki@nihon-u.ac.jp
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. May 26, 2022; 10(15): 4904-4910 Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4904
Importance of abdominal X-ray to confirm the position of levonorgestrel-releasing intrauterine system: A case report
Aki Maebayashi, Kanoko Kato, Nobuki Hayashi, Masaji Nagaishi, Kei Kawana
Aki Maebayashi, Nobuki Hayashi, Masaji Nagaishi, Obstetrics and Gynecology, Nihon University Hospital, Tokyo 1018309, Japan
Kanoko Kato, Kei Kawana, Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo 1738610, Japan
Author contributions: Maebayashi A, Kato K, and Nagaishi M treated the patient; Maebayashi A and Hayashi N diagnosed and wrote the manuscript; Maebayashi A and Kato K contributed to the diagnosis, obtained informed consent, and determined the clinical management of this case; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: 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 according to 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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Aki Maebayashi, MD, Doctor, Obstetrics and Gynecology, Nihon University Hospital, 1-6 Kanda Surugadai, Tokyo 1018309, Japan. maebayashi.aki@nihon-u.ac.jp
Received: September 27, 2021 Peer-review started: September 27, 2021 First decision: October 18, 2021 Revised: November 1, 2021 Accepted: April 3, 2022 Article in press: April 3, 2022 Published online: May 26, 2022
Abstract
BACKGROUND
Levonorgestrel-releasing intrauterine systems (LNG-IUSs) gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea. Complications associated with the insertion include expulsion, displacement, and uterine perforation. Ultrasonic identification of copper intrauterine devices (IUDs) is possible due to echogenicity from the copper coils. However, the barium sulfate coatings of LNG-IUSs do not always provide hyperechoic images. Both barium sulfate and copper are radiopaque and clearly identifiable on X-ray. Thus, X-ray imaging is required to locate LNG-IUSs.
CASE SUMMARY
A 46-year-old woman with hypermenorrhoea due to submucosal myomas was treated with LNG-IUS at another hospital. Three LNG-IUS insertions had apparently been followed by spontaneous expulsion, although objective confirmation using imaging was not performed. The patient was referred to our institution for surgery. At the first visit, there appeared to be no device in the uterus, and none was observed on transvaginal ultrasound. However, two LNG-IUSs were observed in the pelvis on abdominal plain X-rays prior to surgery. Hysteroscopic myomectomy was performed, and the two LNG-IUSs were found to have perforated the myometrium. The devices were safely removed during surgery, and the submucosal myomas were also removed. The perforated section of the myometrium was minimal+ADs- therefore, a repair operation was not required.
CONCLUSION
Plain abdominal X-rays facilitate the determination of whether an LNG-IUS is in the uterine cavity. Therefore, it is important to confirm a device’s location, regardless of whether spontaneous expulsion is suspected, prior to inserting another device.
Core Tip: Levonorgestrel-releasing intrauterine systems (LNG-IUS) is the effective against hypermenorrhea and dysmenorrhea. In many cases, like previous devices, we misunderstand that the device can be recognized by ultrasound. In this case, the diagnosis was that there was no device in the uterus, however, there were two devices that were displaced and caused myometrium damage. Plain abdominal X-ray is important to confirm the position of LNG-IUS.
