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Case Reports
. 2019 Jan;98(3):e13872.
doi: 10.1097/MD.0000000000013872.

Migration of an intrauterine device causing severe hydronephrosis progressing to renal failure: A case report

Xueyan Li  1 , Hongran Li  2 , Chunmei Li  2 , Xiaohua Luo  3 , Yan Song  4 , Shanshan Li  2 , Suiyu Luo  1 , Yu Wang  1
Affiliations
Case Reports

Migration of an intrauterine device causing severe hydronephrosis progressing to renal failure: A case report

Xueyan Li et al. Medicine (Baltimore). 2019 Jan.

Abstract

Rationale: Intrauterine device (IUD) is commonly used in China. Its complications include uterine perforation, IUD ectopic migration, etc. However, a migrated IUD rarely leads to renal failure.

Patient concerns: IUD insertion in the patient was followed by unexplained pain in the left renal area, without bladder irritation or dysuresia.

Diagnoses: Hydronephrosis, renal failure, migrated IUD.

Interventions: The patient underwent laparoscopic and retroperitoneoscopic left nephrectomy, partial ureterectomy, and migrated IUD extraction.

Outcomes: No complications were found after 1 year of follow-up.

Lesson: An IUD should be placed by an experienced doctor. If conditions permit, it is best to perform the procedure under the guidance of ultrasound. The patients should be advised to undergo regular check-ups after the procedure. If necessary, abdominal color Doppler examination should be performed. Importantly, patients with IUD pregnancy must be reviewed.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Contrast-enhanced computed tomography showed severe hydronephrosis and ureterectasis on the left side; and a foreign body was identified near the left lower ureter, which was a migrated (indicated by the arrow) intrauterine device.
Figure 2
Figure 2
Renal dynamic imaging revealed that the left renal blood perfusion was poor and approximately nonfunctional; the right renal blood perfusion and filtration function were normal (arrow pointing to left kidney dysfunction +  intrauterine device).
Figure 3
Figure 3
Single-photon-emission computed tomography (SPECT) image showing almost nonfunctional left kidney.
Figure 4
Figure 4
The intrauterine device (indicated by the arrow) was located close to the lower ureter around 5 cm from the bladder junction during the operation.
Figure 5
Figure 5
A dilated ureter with enlarged pelvis and calyces are seen with gross atrophy of the renal cortex (as shown by the arrow).
Figure 6
Figure 6
Removed ectopic intrauterine device (IUD) step by step from the patient's abdominal cavity by laparoscopy, and pieced together complete IUD on disinfection cloth (as shown by the arrow).
See this image and copyright information in PMC

References

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    1. Zakin D, Stern WZ, Rosenblatt R. Complete and partial uterine perforation and embedding following insertion of intrauterine devices. II. Diagnostic methods, prevention, and management. Obstet Gynecol Surv 1981;36:401–17. - PubMed
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    1. Tuncay YA, Tuncay E, Guzin K, et al. Transuterine migration as a complication of intrauterine contraceptive devices: six case reports. Eur J Contracept Reprod Health Care 2004;9:194–200. - PubMed
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