April 8th, 2020

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Perforated Levonorgestrel-releasing Intrauterine System Resulting in Small Bowel Obstruction: A Case Report
Authors:  Alita Loveless, M.D., Ammar Dhari, M.D., and Charlie C. Kilpatrick, M.D.
BACKGROUND: Complications arising from use of the levonorgestrel-releasing intrauterine system (LNG-IUS) are uncommon. Perforation of the uterus by an LNG-IUS leading to small bowel obstruction (SBO) has not been reported in the literature.

CASE: A 29-year-old woman presented to the emergency department with abdominal pain, constipation, nausea, and vomiting. CT scan revealed dilated loops of small bowel suggestive of SBO and an IUD that did not appear within the uterine cavity. Laparoscopy revealed a dense adhesive band of tissue extending from 2 cm caudad to the umbilical port site to 1 arm of the perforated LNG-IUS at the posterior uterine wall. Two bowel loops were twisted around the adhesive band multiple times. The band was taken down at the IUD and the bowel loops were spontaneously freed. The LNG-IUS was removed.

CONCLUSION: Use of the LNG-IUS is on the rise in the United States and is a recommended first-line contraceptive agent in the obese patient. Management of perforated IUD in an obese patient should take into account individual patient characteristics. Laparoscopic management of a SBO due to a perforated IUD in an obese patient is possible.
Keywords:  IUD, levonorgestel-releasing intrauterine system, small bowel obstruction, uterine perforation
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