Laparotomy for Abdominal Adhesion and Removal of Intrauterine Device from Anatomically Distorted Uterus due to Adhesion in a 43-Year-Old Woman with 3 Previous Cesarean Sections

Patient: Female, 43-year-old Final Diagnosis: Uterine adhesion to abdominal wall Symptoms: Chronic pelvic pain Medication: — Clinical Procedure: Laparotomy Specialty: Obstetrics and Gynecology OBJECTIVE: Unusual clinical course BACKGROUND: Adhesion is a complication of cesarean section. Adhesion of the uterus to the bladder or abdominal wall due to cesarean section can cause discomfort and anatomic distortion. Furthermore, removing intrauterine devices (IUDs) becomes challenging with anatomic distortion of the uterus. This report describes the case of a woman with a history of 3 previous cesarean sections who required laparotomy for abdominal adhesion and removal of an IUD from an anatomically distorted uterus due to adhesion. CASE REPORT: The patient was a 43-year-old woman who presented with pelvic pain. She had an IUD inserted 2 months after her third cesarean delivery 7 years earlier and started to experience chronic pelvic pain with regular and painful menstruation over the last 4 years and worsening since the last 1 year. On clinical evaluation, the thread of the IUD was missing, and ultrasonography confirmed the presence of the IUD inside the uterus. Because the cervix could not be visualized on speculum examination, vaginal removal of the IUD was considered impossible. Since the IUD could not be removed via the vaginal route and hysteroscopy and laparoscopy could not be performed, the patient underwent laparotomy. It was found that the uterus was severely adhered to the abdominal wall, and the IUD was located inside the uterus. Adhesiolysis and IUD removal were performed. The patient was relieved from the chronic pelvic pain. CONCLUSIONS: This report demonstrates the risk of adhesion after multiple cesarean deliveries and the required surgical intervention performed to remove an IUD and adhesiolysis.