Intrauterine rupture of ML Cu 250 device. Report of two cases

: The first case involved a 32-year old nullipara who had had a first trimester abortion by curettage. 2 years after receiving a ML Cu 250 IUD, she requested removal of the IUD but the procedure was done in a incomplete fashion: 1 of the arms of the device broke off and stayed in the uterine cavity. Its position was visualized by echography centrally at the fundus, and it was removed during hysteroscopy under general anesthesia. The second case was a 38-year old patient which 2 previous pregnancies ended in eutocia. She wanted removal of a ML Cu 250 IUD 3 years after its insertion. Partial removal was also effected in this case: an arm of the indented crown remained in the cavity, breaking off at the point of insertion over the central filament. Ecography did not visualize clearly the location of the fragment. Intracavitary maneuvers and subsequently curettage under general anesthesia were performed without success. Hysteroscopy under general anesthesia finally localized the fragment deeply embedded in the endometrium, provoking a virus reaction over the left lateral wall. After attempts at removal with endoscopy, Pean pincers were introduced and fragmented the distal are of the IUD. There have been reports of rupture of IUDs: 1 case of Lippes Loop, 1 case of Cu-7, 1 case of Majzlin spring, and 4 cases of ML Cu 250. Radiological visualization of a fragment is impossible, as the crown is not radiopaque. Hysteroscopy is the intervention of choice in order to avoid inappropriate surgical maneuvers.