Foreign bodies in the uterus. Intrauterine contraceptives (IUD) and their fragments, bone debris, various ligatures are referred to foreign bodies in the uterus.
The clinical picture of foreign bodies in the uterus is more often manifested by various disorders of the menstrual function (menorrhagia, menomerrhagia, acyclic blood discharge). With long-term presence of a foreign body in the uterus, clinical symptoms may manifest secondary infertility, symptoms of chronic endometritis or pyometra. Asymptomatic foreign bodies are possible in the uterus (fragments of the IUD).
Pain occurs when uterus perforation of the IUD and its further migration to neighboring organs with their possible perforation. Migration of the IUD to the epiploon, rectosigmoid angle of the large intestine, retroperitoneal space, bladder, to the cecum, to the region of the vermiform process, to the small intestine, to the uterus appendages is not excluded.
Bone fragments usually become an accidental finding in patients with irregular menstruation, prolonged endometritis, or are detected during examination in women with secondary infertility. In the history it is possible to identify cases of abortion with a long period (13-14 weeks or more), complicated, as a rule, by prolonged bleeding, sometimes with repeated curettage.
Ligatures, usually silk or polyester, are detected in patients with chronic endometritis and pyometry, indicating a cesarean section or a conservative myomectomy in history. Also, patients complain of persistent purulent discharge from the genital tract, not amenable to massive antibiotic therapy, and secondary infertility.
Diagnostics. The main method of diagnosing foreign bodies in the uterus is hysteroscopy, additional methods (ultrasound, if necessary, hydrosonography – GSH and laparoscopy).
Ultrasound. Ultrasound picture with IUD depends on the shape and type of contraceptive. Each type of IUD provides a characteristic clear echogenic image that can vary depending on the location of the contraceptive in the uterus. Optimal for contraception is the location of the IUD, when its distal part is localized in the bottom, and the proximal part does not reach the level of the internal os.
When the IUD is displaced, its proximal part is visualized in the upper third of the cervical canal. The most serious complication of the IUD is uterine perforation, which may be incomplete (the IUD penetrates myometrium) or complete (the IUD partially or completely extends beyond the uterus).
Fragments of the IUD can be determined both in the uterus and in the myometrium in the form of linear inclusions of increased echogenicity, of various sizes, giving an acoustic shadow.
Accurate ultrasound diagnostics of bone fragments is difficult. With ultrasound, they can be defined in the form of separate, ehonsaturated structures of irregular shape. When ligatures in the uterus, ultrasound is not informative.
Hysteroscopy. The endoscopic picture of the IUD depends on the type of contraceptive and the time of the study. The IUD, which is long in the uterus, is partially covered by synechiae and endometrial flaps, salt crystals. If you suspect fragments of the IUD, hysteroscopy should be carried out in the early phase of proliferation, carefully examining all the walls of the uterus. Fragments of the IUD can be represented by a shattered plastic part, metal fragments, “whiskers”; to be free in the uterus or partially penetrate into its wall. When perforation of the uterus of the IUD is detected, hysteroscopy is performed together with laparoscopy.
Hysteroscopy is indicated when UFV fragments remain in the uterus due to unsuccessful removal and there is a suspicion of uterine perforation. With a long stay of the contraceptive in the uterine cavity, sometimes it is tightly attached and even spreading into the myometrium. Hysteroscopy allows you to determine the localization of the IUD itself or its fragments and to remove these foreign bodies precisely.
The hysteroscopic picture of bone fragments depends on the duration of their stay in the uterus. If the period is relatively short, platey, dense, whitish formations with sharp edges, embedded in the uterine wall, are visible. If the bone fragments were long in the uterus (more than 5 years), they have a characteristic crystalline structure (coral-like form) and, when trying to remove them with pliers, fall apart “like sand”. Most often, bone fragments are located in the area of the mouths of the fallopian tubes and in the bottom of the uterus.
Ligatures for hysteroscopy are defined as whitish threads against the background of general hyperemia of the uterine mucosa in its lower third by the front wall (after cesarean section) or in different parts of the uterus wall.