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Case Reports
. 2024 Jan 26:17:71-76.
doi: 10.2147/IMCRJ.S441386. eCollection 2024.

Missed Diagnosis of Perforation and Intraperitoneal Migration of an Intrauterine Device and Its Management in a Resource-Limited Setting: A Case Report

Akebom Gebremichael  1 , Hale Teka  2 , Kidus Kebede Abadi  3 , Melkamu Siferih  4 , Menberu Moges  5 , Muhudin Arusi  1 , Abel Shiferaw  6
Affiliations
Case Reports

Missed Diagnosis of Perforation and Intraperitoneal Migration of an Intrauterine Device and Its Management in a Resource-Limited Setting: A Case Report

Akebom Gebremichael et al. Int Med Case Rep J. .

Abstract

Background: The intrauterine device is a popular and highly effective form of long-acting reversible contraception. Although generally safe, complications could happen. One of the most serious complications of intrauterine device use is uterine perforation. Risk factors for perforation include, but are not limited to, postpartum period, breastfeeding, levels of experience, and excessive force exerted during insertion. This case is significant because it demonstrates risk factors for uterine perforation, how to handle missing strings, and care in places with little resources.

Case presentation: We discuss the case of a 27-year-old black Ethiopian woman who presented with chronic pelvic pain and had a perforated intrauterine device discovered in the cul-de-sac. The device had been inserted at six weeks postpartum. The client was unable to feel the strings three months after insertion, and a wrong diagnosis of expulsion was made. After one year of insertion, the intrauterine device was located on a plain abdominal radiograph and removed via laparotomy without complications.

Conclusion: Although uterine perforation is a rare complication of intrauterine device insertion, special attention should be paid to women with risk factors. In the absence of a witnessed expulsion, assessments and investigations should be carried out before declaring a device expelled. In patients with chronic pelvic pain complaints in the presence of an intrauterine device, perforation and migration outside the uterine cavity should be considered. Abdominal X-rays and laparotomies can be used to find and manage extrauterine migrating devices in environments with limited resources.

Keywords: intraperitoneal migration; intrauterine device; missed uterine perforation.

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Conflict of interest statement

The authors declare that they have no competing interests for this work.

Figures

Figure 1
Figure 1
Erect abdomino pelvic x-ray (AP & lateral) showing radio opaque T-shaped material and intrauterine probe in the pelvis.
Figure 2
Figure 2
The removal process of CU-IUD from the left adnexa and uterine wall captured in pictures.
See this image and copyright information in PMC

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References

    1. Katherine D. Intrauterine contraception: management of side effects and complications. Post TW, editor. UpToDate. Waltham, MA: UpToDate Inc; 2018. http://www.uptodate.com. Accessed May 1, 2023.
    1. Braaten KP, Benson CB, Maurer R, Goldberg AB. Malpositioned intrauterine contraceptive devices: risk factors, outcomes, and future pregnancies. Obstetrics Gynecol. 2011;118(5):1014–1020. doi:10.1097/AOG.0b013e3182316308 - DOI - PubMed
    1. Sufrin CB, Postlethwaite D, Armstrong MA, Merchant M, Wendt JM, Steinauer JE. Neisseria gonorrhea and Chlamydia trachomatis screening at intrauterine device insertion and pelvic inflammatory disease. Obstetrics Gynecol. 2012;120(6):1314–1321. doi:10.1097/AOG.0b013e318273364c - DOI - PubMed
    1. Birgisson NE, Zhao Q, Secura GM, Madden T, Peipert JF. Positive testing for Neisseria gonorrhoeae and Chlamydia trachomatis and the risk of pelvic inflammatory disease in IUD users. J Women’s Health. 2015;24(5):354–359. doi:10.1089/jwh.2015.5190 - DOI - PMC - PubMed
    1. Trussell J. Contraceptive failure in the United States. Contraception. 2004;70(2):89–96. doi:10.1016/j.contraception.2004.03.009 - DOI - PubMed

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