Intraperitoneal migration of an intrauterine device (IUD): A case report

INTRODUCTION: The IUD is one of the most widely used reversible, long-term contraceptive methods in the world. About 80% of IUDs are found in the peritoneal cavity after uterine perforation. CASE REPORT: A 27-year-old female patient presented with chronic pelvic pain with minimal metrorrhagia for 8 months on IUD. On examination, there was no IUD thread. Pelvic ultrasound showed a hypoechoic, heterogeneous, poorly limited formation measuring 3 × 2.68 cm. Abdominal-pelvic CT scan showed hyperdense supravesical material surrounded by a hypo-dense, well-limited collection measuring 26 × 25 mm. Laparoscopy showed an anterior peritoneal collection above the bladder containing the IUD, a uterus, adnexa, and a bladder without abnormality. The IUD was removed after incision of the collection and aspiration of the pus. DISCUSSION: The IUD is one of the most widely used long-term reversible contraceptive methods in the world. But like any foreign body, it can present complications, notably migration after uterine perforation, which remains rare, and even rarer peritoneal localization. The clinical diagnosis is not always obvious, and additional examinations are necessary to locate the device, including endovaginal ultrasound, a CT scan or magnetic resonance imaging. WHO recommends surgical removal of the migrated IUD by minimally invasive methods, including hysteroscopy, cystoscopy, colonoscopy, or laparoscopy, depending on the location of the IUD. CONCLUSION: IUDs are effective contraceptive measures, and the majority of patients with uterine perforation by IUD migration are asymptomatic. Diagnosis is based on a thorough gynecologic analysis and appropriate radiologic imaging.