Clinical Image, J Clin Image Case Rep Vol: 1 Issue: 2

Widened Lippe’s Loop Sign

Charul Dhakad^1* and Anshul Kumar Gupta²

¹Department of Obstetrics & Gynecology, SMS Medical College & Hospitals, Jaipur, India

²Consultant Interventional Cardiologist, Department of Cardiology, Heart & General Hospital, Jaipur, India

*Corresponding Author : Charul Dhakad
Department of Obstetrics & Gynecology, SMS Medical College & Hospitals, Jaipur, Rajasthan, India
Tel: +91 96116 18601
E-mail: charul.ims@gmail.com

Received: September 13, 2017 Accepted: September 25, 2017 Published: October 02, 2017

Citation: Dhakad C and Gupta AK (2017) Widened Lippe’s Loop Sign. J Clin Image Case Rep 1:2.

Keywords: Lippe’s loop; Intrauterine contraceptive device; IUD; Widenend loop sign

Introduction

A 62 years lady with diabetes and hypertension presented to emergency room with anginal chest pain of 8 hours duration. Clinical examination was unremarkable except for tachycardia. Electrocardiogram showed Acute Anterior wall myocardial infarction. Her coronary angiogram revealed triple vessel atherosclerotic coronary artery disease. During fluoroscopy, a Lippe’s loop and a copper-T Intrauterine contraceptive device (IUD) were incidentally seen (Figure 1). She recalled insertion of Lippe’s loop around 45 years back. Lippe’s loop was seen misplaced to left side with marked widening of its loops.

Ronald L Eisenberg in 1972 described “widened loop sign” as a preemptive radiological sign of uterine perforation [1]. In 1985, production and marketing for Lippe’s loop were stopped and these devices are uncommonly encountered in current clinical practice [2]. Perforations may present acutely with severe abdominal pain or later with dysfunctional uterine bleeding, secondary infertility, or infection [3,4]. However uterine perforationmay remain asymptomatic as well, for years [5]. Widened loop sign helps us to suspect uterine perforation. While the distance between loops is usually 5 mm or less inside uterus (due to small cavity size), it gets widened to its normal configuration of about 1 cm if the device gets displaced outside the confines of uterine cavity. Later on, patient’s workup revealed Cervical intraepithelial neoplasia and she underwent total abdominal hysterectomy with difficult removal of Lippe’s loop adhered near sigmoid colon.

References

1. Ronald L Eisenberg (1972) The Widened Loop Sign of Lippe’s loop perforations. Am J Roentgenol 116: 847-852.
2. (1985) Ortho stops marketing Lippes Loop; cites economic factors. Contracept Technol Update 6: 149-152.
3. Agarwal N, Kriplani A (2000) Secondary infertility and dysfunctional bleeding from a Lippes Loop placed 32 years earlier. Int J Gynaecol Obstet 69: 167-168.
4. Kriplani A, Buckshee, Relan S, Kapila K (1994) Forgotten intrauterine device leading to actinomycotic pyometra- 13 years after menopause. Eur J Obstet Gynecol Reprod Biol 15 :215-216.
5. AniulienÃ?Â? R, Aniulis P (2014) Lippes Loop intrauterine device left in the uterus for 50 years: case report. BMC Women's Health 14: 97.