- 期刊
避孕器移位引發下腹部疼痛
Displacement Intra-uterine Device Induces Persistent Low Abdominal Pain
摘要
常見的避孕方式有：保險套、子宮內避孕器、口服避孕藥。儘管裝置子宮內避孕器常見有下腹疼痛、腰酸、點狀出血、月經量增加及日數延長等副作用，但是裝置子宮內避孕器仍是國內已婚婦女最普遍選擇的方式。避孕器裝置不當除有以上的副作用外更可能造成身體嚴重的傷害。我們報導一病例為34歲女性，在裝置子宮內避孕器後開始有間歇性下腹疼痛，一直在門診接受治療。治療期間下腹痛不但沒有改善，這半年來下腹疼痛變得越來越嚴重。在詢問病史時病患主訴：於民國八十九年生完第二胎後在第一家醫院裝置子宮內避孕器。民國九十一年又再懷孕而行人工流產手術，此時避孕器因找不到而未取出。同年底在大陸的醫院又再裝置一次環形的避孕器。民國九十六年十二月在本院婦產科門診就醫時以超音波檢查時發現子宮內只有一個環型避孕器。再進一步腹部X光檢查，發現：有兩個避孕器。懷疑另外一個避孕器已掉入腹中，故安排以子宮腔鏡檢查只發現另一個環形避孕器，但並未發現另一個避孕器，故再行腹腔鏡手術，在子宮直腸隱窩壁上找到一端突出於直腸前的T型避孕器，我們以腹腔鏡手術取出。手術後病人自覺下腹疼痛已完全改善，並順利於兩天後出院。我們要提醒大家注意裝置避孕器雖然是婦產科門診常見的處置，但裝置不當亦可能危害身體健康。
並列摘要
The most common methods for contraception are: condom, intra-uterine device (IUD), and oral contraceptives. Although use of an IUD sometimes causes the side effects of inducing low abdominal pain, back pain, vaginal spotting, metrorrhagia and menorrhagia, IUD use has became the most frequent choice for the married women in Taiwan and China. An inappropriate IUD installation will cause not only the above side effects but also introduces the risk of serious damage. We report a case of a misplaced IUD. After the birth of her second child in 2000, a 34 years old woman, installed an IUD (Nova T). After which she started to have intermittent pain in her lower abdomen, which she made repeated attempts to treat through outpatient visits to her doctor. During her treatment period, her pain never improved and instead became more and more severe over a period of half a year. In 2002 she became pregnant again but she induced an elective abortion. The IUD (Nova T) was not removed because it could not be found at that time. She subsequently had a ring IUD installed in China at the end of the same year. In an attempt to diagnose the pain she continued to have, a sonograph inspection was performed in the outpatient department of our hospital in the December of 2007. Only the ring IUD was observed in the uterine cavity. Using a further X-ray inspection of the patient’s abdomen, the 2nd IUD was observed. We suspect the other IUD (Nova T) was misplaced. Therefore, a hysteroscopic inspection was arranged, during which only the ring IUD was found. During a subsequent laparoscopic surgery, the IUD (Nova T) was found at cul-de sac, and removed. . After the surgery, her abdominal pain subsided completely and she was discharged two days later without complications. It is our duty to remind the public that the inappropriate IUD installation can jeopardize a woman’s health; even though it is a common treatment in the gynecologic and obstetric practice.