Foreign body in uterine cavity is the presence of a foreign object in the cavity or wall of the uterus, accompanied by a complex of pathological disorders. Foreign body in uterine cavity can manifest themselves by bleeding, chronic endometritis, pyometra, pain syndrome, secondary infertility. Foreign body in uterine cavity are detected by ultrasound, hysteroscopy, probing. Removal of foreign bodies of the uterus can be performed during hysteroscopy, curettage of the uterine cavity, laparoscopy; in complicated cases, hysterectomy may be required.
In the uterine cavity, the presence of freely lying or ingrown intrauterine contraceptives and their parts (threads, plastic hangers, metal fragments), surgical ligatures, fetal bone fragments is often found. Sometimes foreign bodies trapped in the uterus are encapsulated and do not manifest themselves for a long time. In other cases, foreign bodies can move with muscle contraction, cause perforation of the uterine wall and migrate into the abdominal cavity or retroperitoneal space. Infection of foreign bodies of the uterus causes a chronically ongoing inflammatory process that does not respond to active therapy. The problem of detecting and removing foreign bodies of the uterus in clinical gynecology has its relevance due to the likelihood of developing a wide range of dangerous complications.
Clinically, foreign bodies of the uterus usually manifest themselves as changes in menstrual function – menorrhagia, metrorrhagia, bloody discharge. In the case of prolonged stay in the uterus, foreign bodies cause chronic endometritis, secondary infertility, and sometimes the development of pyometra. The presence of fragments of the IUD may be asymptomatic.
The appearance of pain syndrome, as a rule, indicates perforation of the uterine wall by parts of the IUD and can lead to further migration of objects and injuries to neighboring organs. The perforation of the uterus can be partial (the IUD is embedded in the myometrium) and complete (the IUD completely or to some extent extends beyond the uterine wall). During the migration of foreign bodies from the uterus, they can be found in the area of the omentum, rectosigmoid angle, bladder, appendicular process, appendages of the uterus, retroperitoneal space, in the caecum or small intestine.
Fetal bone remains are most often accidentally found in patients examined for long-term endometritis, menstrual disorders, secondary infertility. In the anamnesis of this category of women, termination of pregnancy at a period of 13-14 weeks or more is detected, as a rule, complicated by bleeding and repeated curettage of the uterine cavity. Lavsan or silk ligatures are usually detected in patients with endometritis, pyometra, obstetric or gynecological interventions (cesarean section, conservative myomectomy, etc.). In this regard, patients are concerned about purulent white spots, secondary infertility.
The main method of detecting a foreign body of the uterus, which gynecology has today, is hysteroscopy. The remaining instrumental studies (examination on a chair, probing, ultrasound, laparoscopy) are of auxiliary importance. During gynecological examination, a foreign body in the uterus can be detected using a probe. The disadvantage of probing the uterine cavity is the inability to determine the exact location of the object, its nature, shape and size, relation to the walls of the uterus and neighboring organs.
Transvaginal or transabdominal ultrasound is more informative for the detection of intrauterine contraceptives. Fragments of the IUD in the form of zones of increased echogenicity can be detected directly in the uterine cavity or in the thickness of the myometrium. Ultrasound diagnostics of bone remains and ligatures in the uterine cavity is difficult and uninformative.
The hysteroscopic picture depends on the nature of the foreign body of the uterus. Foreign bodies that have been in the uterus for a long time can be covered with endometrium, intrauterine synechiae, salts, and also form bedsores in the uterine wall. With the help of hysteroscopy, it is possible to determine the localization of a foreign body of the uterus and conduct its targeted removal. Bacteriological examination of the smear allows you to choose an adequate antibiotic therapy based on the sensitivity of the microflora to the drug. Foreign bodies lying freely in the abdominal cavity are detected during an overview radiography.
Removal of foreign body in uterine cavity
Foreign objects lying in the uterine cavity can be precisely extracted through the hysterocope channel with endoscopic instruments. It is not recommended to remove foreign bodies of the uterus blindly, since such attempts can lead to fragmentation and deformation of foreign objects, as well as injury to the uterine wall. If partial or complete perforation of the uterine wall is detected, hysteroscopy is combined with laparoscopy.
In the case of ingrowth of foreign bodies into the thickness of the endometrium, curettage of the uterine cavity with the removal of the detected fragments is indicated. Sometimes colpohysterotomy is resorted to for the extraction of foreign bodies – extra-vaginal dissection of the uterus. In situations where foreign bodies go beyond the uterus, penetrate into neighboring organs or the abdominal cavity, a laparotomy is performed with a revision of the organs concerned.
If the presence of a foreign body in the uterus is complicated by perforation and massive infection, removal of the uterus may be required: supravaginal amputation or hysterectomy. In the postoperative period, antimicrobial treatment is carried out. Prevention of finding foreign bodies in the uterus consists in careful monitoring of the condition of the uterine cavity after removal of the IUD, abortions, gynecological operations.