Successful endoscopic management of 3 cases of translocated intrauterine devices: a case report

Abstract

Intrauterine devices (IUDs) are the most popular form of contraception globally; however, the use of IUDs carries some risks. IUD migration is a rare but serious complication that occurs after insertion, sometimes years later. Herein, we report 3 cases of translocated IUDs removed by endoscopy and describe the clinical characteristics and intraoperative findings of these patients. Case 1 was a 46-year-old woman who presented with upper abdominal pain. Gastroscopy showed the presence of an IUD inside the stomach. Digestive endoscopy performed at our hospital showed a T-shaped foreign body embedded in the gastric wall at the junction between the gastric antrum and the gastric body. The IUD was removed endoscopically without complications. Case 2 was a 36-year-old woman who had twice undergone cesarean section. Two months before presenting at our hospital, the patient experienced external hemorrhoid. During anal suppository treatment, she felt a lump inside the rectum. Pelvic computed tomography revealed a small, circular dense shadow with an approximate diameter of 0.4 cm in the upper intestinal cavity of the rectum. Subsequently, the patient received transanal endoscopy and rectal foreign-body removal surgery. Case 3 was a 40-year-old woman. She had failed to remove an IUD in other 2 hospitals. On the basis of pelvic computed tomography, the IUD was suspected to have perforated the bladder. Cystoscopy showed that part of the IUD was surrounded by stones. Laser lithotripsy was performed to expose the IUD completely. Under hysteroscopy, the IUD could be seen in the middle of the uterine cavity; 1 end was located on the right uterine horn, and the other was protruding out of the uterus. During the operation, the IUD was broken into two parts and one part was removed through the vagina. The cystoscope was placed again, and the remaining part of the IUD was smoothly removed. Although IUD migration has a low incidence, it can have a huge impact on patients' physical and emotional health. Migrated IUDs must be removed immediately. Hysteroscopy and digestive endoscopy are effective approaches for removing migrated IUDs.

Keywords: Intrauterine device (IUD); case report; digestive endoscopy; hysteroscopy; migration.