Presentation
Case Findings: A 70-year-old woman presents complaining of back pain. She had no history of abdominal surgery or other abdominal symptoms. An X-ray was ordered.What is your diagnosis?
Learnings
The X-ray revealed a rare finding: a Lippes Loop. This intrauterine device was popular between the 1960s and 1980s as a permanent birth control option. In this case, it may have placed without the patient’s knowledge, but this was not confirmed. Her back pain was a result of degenerative change in the spine with compression of the L5 vertebra over time.
Current IUD options similar to the Lippes Loop include a copper IUD such as the ParaGard. Advantages of a copper IUD include a lack of the possible side effects associated with a hormonal device. However, uterine abnormalities, pelvic infections, or a history of difficulty with other types of IUDs are reasons against using a copper contraceptive device
What to Look For:
Consider a forgotten or ignored Lippes Loop as part of the differential diagnosis in women who were of reproductive age between approximately 1960 and 1980 who present with nonspecific abdominal or back pain. A 2015 case report and literature review published in the Journal of Clinical and Diagnostic Research described a case of a Lippes Loop left in place for 45 years before the patient presented with postmenopausal bleeding and abdominal pain.
Treatment:
A Lippes Loop may be removed even decades after placement, although the process may be complicated by tissue atrophy. The World Health Organization recommends removal of misplaced IUDs when identified, although some arguments persist that removal of long-inert IUDs in asymptomatic women could lead to unnecessary complications.
Make the Diagnosis: Baffling Lower Back Pain
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