COLOCOLIC FISTULA CAUSED BY A PREVIOUSLY INSERTED INTRAUTERINE-DEVICE- CASE-REPORT

Uterine perforation remains the most serious complication of the intra uterine contraceptive device (IUD). It is more common in the puerperiu m, usually occurring at the time of insertion of a new device. perfora tion may, however, also occur in the puerperium if a pre-existing devi ce is not removed in early pregnancy or extruded at the time of delive ry. The case is presented of a 30-year-old woman who became pregnant f or the third time following insertion of an IUD in the puerperium of h er second pregnancy. An uneventful pregnancy and delivery followed. Fa ilure to detect the IUD at the time of delivery led to laparoscopy and laparotomy to locate the device. A colotomy was necessary to retrieve the device, which had formed a colocolic fistula. It is concluded tha t the puerperium remains the time of greatest risk of uterine perforat ion by an IUD. Although most occur at the time of insertion, this comp lication can also occur with a previously inserted device. Severe intr a-abdominal complications may ensue if the device is not localized and removed. Laparotomy is justified if the laparoscopic removal is unsuc cessful. A high degree of suspicion is necessary if serious consequenc es are to be avoided. (C) 1997 Elsevier Science Inc. All rights reserv ed.