Ineffective Pelvic Magnetic Resonance Imaging for the Detection of a Levonorgestrel-releasing Intrauterine System Straying into the Abdominal Cavity

The levonorgestrel intrauterine system (LNG-IUS) is used by patients for dysmenorrhea, but cases of uterine perforation have been observed. This patient underwent replacement 5 years after the initial LNG-IUS insertion, but persistent abdominal pain led to a visit to her previous gynecologist. Trans...

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Bibliographic Details
Main Authors: Kensuke Ogino, Hiroe Ito, Koji Fujimori, Junko Nakagawa, Keiichi Isaka, Yasufumi Oishi
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-04-01
Series:Gynecology and Minimally Invasive Therapy
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Online Access:https://journals.lww.com/10.4103/gmit.GMIT-D-24-00009
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Summary:The levonorgestrel intrauterine system (LNG-IUS) is used by patients for dysmenorrhea, but cases of uterine perforation have been observed. This patient underwent replacement 5 years after the initial LNG-IUS insertion, but persistent abdominal pain led to a visit to her previous gynecologist. Transvaginal ultrasonography and magnetic resonance imaging (MRI) at the time of the visit did not detect LNG-IUS. A subsequent computed tomography (CT) scan clearly showed the entire T-shape of the LNG-IUS on the sagittal plane and revealed the presence of the LNG-IUS in the abdominal cavity. Laparoscopic observation revealed that the adhesion of the LNG-IUS was mild, and it could be removed without damaging other organs. The patient was discharged without problems on the third postoperative day. LNG-IUS extraction via ultrasonography and MRI is considered challenging due to its material characteristics. We report a case of intrabdominal LNG-IUS migration where CT and X-ray proved useful in the localization of LNG-IUS.
ISSN:2213-3070