Fallopian tube insertion into the uterine cavity discovered accidentally during laparoscopic retrieval of a misplaced coil from the pelvic cavity
© Springer-Verlag 2007
Received: 4 May 2007
Accepted: 4 July 2007
Published: 15 August 2007
This article presents for the first time in the literature a case of fallopian tube insertion into the uterine cavity discovered accidentally during laparoscopic retrieval of a misplaced coil from the pelvic cavity.
Uterine perforation during insertion of a contraceptive device (coil) is rare and has been estimated as 1 in 1,000 insertions. However, this percentage may be increased if the insertion is performed immediately after a termination of pregnancy. In these cases, experienced gynaecologists are often involved in order to prevent such complications or misplacement of the coil.
A 22-year-old woman had a surgical (suction–aspiration) termination of a 9-week pregnancy. She opted for an intrauterine contraception device which was inserted at the end of the operation.
The perforation of the posterior wall explains the misplacement of the coil. However, it is difficult to explain when this perforation occurred and how the fallopian tube was inserted into the uterus. The most plausible explanation is that the uterine perforation occurred during the evacuation of retained products of conception and that at this moment the fallopian tube was aspirated into the uterine cavity. The coil probably passed directly to the abdominal cavity through the perforation without returning the tube back into the pelvis. The pressure difference between pelvis and uterine cavity may explain possible adherence between the nearest organ (in our case the fallopian tube) and the uterine posterior wall, but this could not explain how 4–5 cm of the fallopian tube was introduced into the uterine cavity. Few reports of aspirated bowel with suction–evacuation during termination of pregnancy have been reported and none involve the fallopian tube. There are serious risks of bowel perforation or pelvic abscess if bowel is involved [1–3]. In cases of misplaced coil into the abdominal cavity without bowel perforation, the patient risks pregnancy, pelvic infection, adhesion formation, and chronic pain . The inflammatory aspect of the fallopian tube could be explained by its abnormal placement in the uterine cavity and by mild ischemia due to the mechanical compression from myometrium. For our patient, prompt diagnosis and management was successful. Most of the authors agree that removal of intraperitoneal coil is necessary as it provokes local inflammation and adhesion formation [5–7]. In our case, fibrin deposits had already formed around the coil, which was surprisingly early considering that only 4 days had past since its insertion. The laparoscopic location of the coil can be tricky if there is no sign of adhesions . An abdominal X-ray can point out the side where the coil is located. During laparoscopy, careful bowel manoeuvres should be undertaken in order to detect the coil. Laparoscopic retrieval of the missed coil is considered the standard approach, and laparotomy is performed very rarely [7, 9, 10]. Finally, fallopian tube insertion into the uterine cavity discovered accidentally during laparoscopy is a very rare clinical scenario. Even though a misplaced coil in the abdominal cavity can be easily retrieved by laparoscopy, the need for thorough inspection of all the organs should be mandatory. In our case, “just removing the coil” without systematic inspection of the pelvic organs could miss such a rare complication with future adverse effect on the patient’s fertility.
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