Clinical Information:
The female patient had
lower abdominal pain for years with missing IUD and a progressive abdomen
fullness for months. Abdomianal X-ray showed IUD within the abdominal cavity,
which can not be seen by ultrasound.
Operative Procedures:
On
IV drip with IC needle and under general anesthesia, the patient was placed in
the dorsal lithotomy position with both legs wrapped with elastic bandage.
Prophylactic antibiotics with 500mg of Cefamezine was given immediately before
the operation. The abdominal wall was sterilized with soap solution and alcohol
betadine and the vagina and the cervix with aqua betadine. And later, the
patient was properly draped. Then the uterine manipulator was inserted through
the cervix and locked in place.After the adequate pneumoperitoneum established
with Veress needle, the 10 mm principal trocar and cannula were inserted
through a periumbilical incision. The videolaparoscope was then introduced. The
patient was placed in the Trendelenberg position and was thoroughly surveyed
inside of the upper and lower abdomen. Under the monitor of the telescope, two
further portals were inserted, one in the left and the other in the right lower
quadrants at about the McBurney's points, depending upon the size of the
adnexal mass. A plastic bag was then inserted via the trocar site into the
pelvic cavity. The IUD was then put into the plastic bag and later removed
within the bag. Then the whole pelvis and operation sites were irrigated
thoroughly and under-water examination was performed to ensure that there is
with proper hemostasis. After the vacuum-ball drainage was inserted into the
pouch of Douglas through the previous lower abdominal portal, the laparoscopic
instruments were then removed, the abdominal cavity deflated, and the incisions
closed. The patient was sent to POR intensive care unit for recovery and
respiratory support. The patient stood the procedure well and was in stable
condition.