Management of an Intrauterine Device Migration Resulting in a Pregnancy - Clinical Case

Abstract

Intrauterine devices (IUD) are one of the most commonly used methods of contraception worldwide. The long term effect makes it desirable by most patients. The insertion of an IUD is not difficult as a technique but it involves multiple complications such as uterine perforation and migration into the abdominal cavity, urinary bladder perforation, fistula formation, bowel perforation and intra-abdominal adhesions. We present the case of a 31-year-old female patient (para=4) with a medical history of an IUD insertion during her postpartum period in February 2018. In April 2019, during her normal follow up consultation, the speculum examination did not detect any IUD strings and the abdominopelvic ultrasound showed no signs of the device inside the uterine cavity. A subsequent X-ray identified the device in a horizontal position in the pelvic region. The patient was scheduled for surgical intervention, but in the meantime she became pregnant. Decision to continue with the pregnancy was taken and surgery was delayed until the postpartum period. In August 2020, a laparoscopic surgical procedure was performed; during the intervention, the IUD was identified in the anterior rectal wall with only the strings exiting the wall. Therefore, a visceral surgeon advice was required. The device was removed by continuing the laparoscopic intervention. The patient was given antibiotic treatment and had a favorable evolution. Although IUD is thought to be an easy and accessible method of contraception, complications such as uterine perforation must always be taken in consideration and well explained to all patients.