[A more and more painful intrauterine device where it is not enough to see the wires to exclude malposition!]. / Un stérilet qui fait de plus en plus mal où il ne suffit pas d'en voir les fils pour exclure une malposition !

We report a case of a 30-year-old woman with an intrauterine device (IUD) improperly inserted deep within the myometrium, with a muscularis layer injury of the recto-sigmoid colon resulting of a uterine perforation and presented as abdomino-pelvic pain and dyspareunia. The ultrasonographic control of the IUD after the insertion (performed seven months before) was not checked. Cervical examination showed the strings of the IUD. The ultrasonographic exploration identified an intra-myometrial IUD with fundus perforation of the uterus. A laparoscopic exploration permitting the removal of the IUD revealed an insertion through the bowel wall. The lessons to draw of about this case report are discussed through a brief review of the literature.

[Imperforate hymen: one diagnosis can hide another]. / Imperforation hyménéale : un diagnostic peut en cacher un autre.

INTRODUCTION: A case of imperforate hymen discovered after a surgical complication is reported. We discuss the lessons to draw from this case in terms of diagnosis and therapeutic management. CASE REPORT: An 11-year-old girl was referred with fever and acute lower abdominal pain. A diagnosis of appendicitis was hypothesized because of rigidity located to the right iliac fossa, a psoas sign, polynuclear leukocytosis, and increased serum C-reactive protein. A McBurney laparotomy showed a brownish hemoperitoneum and a dilated right fallopian tube. The appendix appeared normal and an appendicectomy was done. A diagnosis of hematocolpos aggravated by hematometra, hematosalpinx, and hemoperitoneum was suspected. Pelvic examination revealed an imperforate hymen with a taut pelvic mass confirmed by transabdominal and endorectal ultrasonography. Hymenotomy was performed, which allowed the discharge of 400cc of chocolate-colored fluid. The history-taking revealed recurrent intermittent lower abdominal pain with several referrals to emergency departments. The patient recovered uneventfully and was discharged 2 days later. CONCLUSION: In case of acute abdominopelvic pain in pubertal girls with no previous menstruation, the possibility of an imperforate hymen must be suspected. Examination should include observation of secondary sexual characteristics and inspection of the external genitalia. Treatment is surgical and consists of a hymenotomy.