Uterine perforation with Lippes loop intrauterine device-associated actinomycosis - A case report and review of the literature

A case of a 67-year-old postmenopausal woman, gravida 2, para 2, with an ut erine perforation from actinomycotic infection with Lippes loop IUD is repo rted. She had the Lippes loop IUD inserted for 35 years, and had never had any pelvic examination nor Papanicolaou smear. She presented with acute abd ominal pain. The clinical picture mimicked peptic ulcer perforation. The wo man underwent laparotomy and exudative fluid was discovered in the abdomina l cavity with the tip of the Lippes loop IUD at one of the two small holes of the uterine fundus. Total abdominal hysterectomy with bilateral salpingo -oophorectomy was performed. The postoperative microscopic pathological rep ort demonstrated characteristics of actinomycosis. She was treated with par enteral high-dose penicillin for 4 weeks followed by oral penicillin for 6 months. The woman had an uneventful recovery. To our knowledge, this is the first case report of uterine perforation due to Lippes loop IUD-associated actinomycotic infection. (C) 2000 Elsevier Science Inc. All rights reserve d.