Pelvic abscess complicating sigmoid colon perforation by migrating intrauterine device: A case report and review of the literature

Abstract

Introduction: Intrauterine devices (IUDs) are commonly used as a contraceptive method. However, they may cause rare but potentially serious complications such as migration through the uterine wall and gastrointestinal perforation.

Presentation of case: We report a case of a 26-year woman, carrying an IUD for 2 years, who presented to the emergency with pelvic pain with breakthrough bleeding. Abdominal imaging revealed the presence of two devices the first of which was located in the uterine cavity and the other in the wall of the sigmoid colon associated with a 5-centimeter pelvic collection. Intraoperatively, the IUD was found to be embedded in the wall of the sigmoid colon which was removed by wedge resection of the involved segment followed by a closure of the puncture with drainage.

Discussion: The Intrauterine Device (IUD) is an effective method of contraception, relatively well tolerated, reversible, inexpensive and widely used. However, it is not without risk. Indeed, serious complications can occur such as uterine perforation and migration to adjacent abdomino-pelvic structures. Our observation illustrates its rarity given the fact that this complication has been observed the first time in our department over the last ten years.

Conclusion: The migration of IUD must be treated even in asymptomatic patients due to the risk of severe complications.

Keywords: Intrauterine device; Perforation; Sigmoid colon.

Fig. 1

Cross-section CT showing two devices, the first up in the uterine cavity and the second having an ectopic position which vertical branch is in the light of the sigmoid colon and both arms are embedded in the wall with a close 5 cm collection.

Fig. 2

Intraoperative images showing a device embedded in the wall of the sigmoid colon.

Fig. 3

Intraoperative image showing perforation of the sigmoid colon after removal of the device.