Successful removal of an embedded intrauterine contraceptive device (IUD) under ultrasonic guidance and local anesthesia is reported in a case in which conventional methods of removal had failed.
CASE REPORT
A 32-year-old gravida 2 para 2 woman was referred to our institution for hysteroscopic removal of a Lippes' loop that had been in place for 9 years. Previous attempts to extract the IUD had failed. During the first attempt 3 weeks earlier, the IUD string had broken while being pulled during an office pelvic examination. An abdominal film taken 1 day later indicated that the Lippes' loop was probably in an appropriate location for intrauterine manipulation. During a subsequent dilatation and curettage under general anesthesia, the IUD was felt but still could not be removed. The patient was referred for hysteroscopic removal of the IUD.
Physical examination at our institution disclosed that the abdomen was soft, without masses, and with normal bowel sounds. External and internal pelvic examinations were normal, revealing a multiparous cervix. On real-time ultrasound examination (Fig. l), the Lippes' loop was located primarily intracavitary but partially embedded in the posterior superior aspect of the uterine fundus, without penetration through the myometrium. After completion of the preliminary scan, 10 ml of 1% lidocaine was administered as a paracervical block in an arc from 2-10 o'clock around the cervix. Under continuous-