Title: "Forgotten" intrauterine device leading to actinomycotic pyometra -- 13 years after menopause.

POPLINE Document Number: 097974

Author(s):

Kriplani A
Buckshee K
Relan S
Kapila K

Source citation:

European Journal of Obstetrics, Gynecology and Reproductive Biology, 1994;53(3):215-6.

Abstract:

A 59-year-old Indian woman presented with a case of a "forgotten" intrauterine device (IUD), which resulted in an Actinomyces israelii infection and pyometra. The patient described a two-month history of foul-smelling, bloody vaginal discharge accompanied by an intermittent, low-grade fever. She had been post-menopausal for 13 years. She had had a lippes loop IUD inserted 22 years earlier and had forgotten it, but had not presented any problems. Nothing abnormal was found during a general physical exam. However, during speculum examination a foul-smelling pus discharge through the cervical os was discovered. Some erosion to the anterior lip of the cervix was noted, and the blackened strings of the IUD were seen at the cervical os opening. Vaginal examination showed an enlarged uterus that was soft, with fornices being thickened and tender to palpation. The uterus was found to be retroverted. Further analysis yielded an Hb of 12.1 g% and a TLC of 13,000. The patient's urine was examined by microscopy and culturing. Both were normal. Also normal were her blood sugar, KFT, LFT, and chest X-ray. However, an ultrasound image showed an IUD in the uterus. A pyometra was also found. The pyometra was drained and the IUD removed. An infection of Actinomyces israelii was found following cytological examination of the pus discharge. An antibiotic course of 100 mg b.d. doxycycline was given for 14 days. During two follow-up examinations (2 and 6 months post-IUD removal), laboratory specimens from an endometrial aspirate and endocervical curettage were taken, but the only condition noted was an atrophic endometrium.

Keywords:

India
Case Histories
IUD Complications
Cervical Effects
Uterine Effects
Endometrial Effects
Reproductive Tract Infections
Complications
Asia, Southern
Asia
Developing Countries
Data Collection
Research Methodology
IUD
Contraceptive Methods
Contraception
Family Planning
Cervix
Uterus
Genitalia, Female
Genitalia
Urogenital System
Physiology
Biology
Endometrium
Infections
Diseases