(178) Cuban IUD Syndrome

Abstract Introduction For decades, clinicians have evaluated immigrant women presenting with lower abdominal pain, typically chronic and severe. After numerous differential diagnoses and surgical procedures (including appendectomy, management of ruptured ovarian cysts, and pelvic masses), the final diagnosis has frequently been tubo-ovarian abscesses. In collected data, over 96% of these women were found to have an intrauterine device (IUD) in place, and in approximately 50% of cases, the presence of the IUD was unknown even to the patient herself at the time of evaluation Objective To describe a newly recognized clinical entity, primarily observed among immigrant women (particularly of Cuban origin) in a region of the United States, characterized by chronic pelvic inflammatory disease and tubo-ovarian abscesses associated with long-term IUD use. The study aims to highlight the strong association between the use of expired IUDs and the development of this severe pathology. We also report that Indian-manufactured IUDs (despite being banned in most countries) are still in use in certain regions such as Cuba, and are the most strongly associated with the condition we term "IUD syndrome". Methods We report on a cohort of 82 women, aged 31 to 74 years, diagnosed with tubo-ovarian abscesses in the context of long-term IUD use, all treated at a single hospital located in a region with a high concentration of Cuban immigrants in the United States. Of these patients, 92% were Cuban immigrants, and 2% were American women whose IUDs had been inserted in Cuba. Outdated plastic tie IUDs and ring-shaped IUDs made from fishing line were associated with this condition. The duration of IUD use among these patients ranged from 5 to 52 years, with the majority between 20 and 32 years. Results Sixty-five percent of cases required surgical treatment (via laparotomy, laparoscopy, or robotic approach) for drainage, irrigation, and culture of the abscesses, followed by intravenous and oral antibiotics. Twenty-five percent of patients responded well to hospitalization and intravenous antibiotic therapy alone. Ten percent required repeated medical or surgical interventions due to recurrence of infection. Although no patients died, four required intensive care unit admission due to severe peritonitis secondary to multiple tubo-ovarian abscesses. Since the surge in immigration over the past four years, the number of cases diagnosed has markedly increased. Conclusions Sociopolitical conditions, educational disparities, lack of resources, and poor follow-up care are critical factors influencing patient health outcomes. The tubal-ovarian abscesses associated with long-term IUD use, which we refer to as the "Cuban IUD Syndrome,” are increasingly encountered in specific immigrant communities. Poor aseptic technique, limited resources during IUD insertion, and lack of provider training may also contribute significantly to the development of this disease Disclosure No