Intra-uterine granulation tissue with an intra-uterine contraceptive device in situ for 16 years.

PIP: This case report tells of intrauterine granulation tissue with an IUD in situ for 16 years. The 43-year-old patient had had 6 pregnancies, the last 16 years ago. After the last delivery she was fitted with a Lippes Loop IUD. She presented with a 2-week history of heavy intermenstrual bleeding, which had failed to respond to norethisterone. She had no other significant past medical history. General examination was normal. On pelvic examination the uterus was found to be bulky and anterverted, and the threads of the IUD were visible. She was admitted for dilatation and curettage, and the findings were confirmed. The IUD was removed, a uterine sound passed to 9 cm, and the cervix dilated to 9 mm. Normal looking curettings were obtained and sent for histological examination. The patient was fitted with a copper containing IUD. Histological examination of the curettings revealed an inflammatory infiltrate of plasma cells and lymphocytes superimposed on a proliferative endometrium. In addition to this, there were separate strips of simple granulation tissue composed of proliferative capillaries and venules in an edematous, necrotic background, containing lymphocytes, polymorphocellular cells and macrophages. There was no evidence of tuberculosis or actinomycosis on appropriate staining. Abnormal bleeding developing some time after insertion should always be investigated. In this patient no cause was found for the prolonged bleeding other than the granulation tissue. An intrauterine contraceptive devices are believed to work by causing inflammation and are associated with an increased incidence of pelvic inflammatory disease, it comes as a surprise that associated granulation tissue has not been reported previously.^ieng