Asymptomatic uterine perforation and IUD migration to the broad ligament: A case report

Abstract

Rationale: Uterine perforation is a serious complication of intrauterine contraceptive device (IUD) placement. However, as complete uterine perforation and extrauterine migration may remain asymptomatic, thorough localization of the IUD is important prior to reinsertion.

Patient concerns: A 33-year-old patient who has had 4 IUD insertions, wherein the location of the first IUD (inserted 14 years ago) was not identified prior to reinsertion and replacement of the subsequent three. She presented to hospital with a 6-month history of abdominal pain. Pelvic ultrasonography (US), radiography, hysteroscopy and laparoscopy examinations confirmed that a retained migrated IUD in the right broad ligament.

Diagnosis: Uterine perforation, IUD migration to the broad ligament.

Interventions: The patient underwent hysteroscopy and laparoscopy.

Outcomes: Both IUDs were successfully removed without any complications.

Figure 1.

(A) Metal-like hyperechoic spots within (red arrow) and outside of (yellow arrow) the myometrium of the right side of the uterus on ultrasonography. (B) An IUD normally positioned in uterine cavity (red arrow) on ultrasonography. (C) Two irregular high-density shadows in the pelvic cavity (red arrow) on abdominal X-ray.

Figure 2.

(A) The normal V-shaped IUD in the uterine cavity on hysteroscopy. (B) Adhesions of the separated greater omentum with the anterior lobe of the right round ligament and the right broad ligament (red arrow) on laparoscopy. (C) One arm of the migrated IUD in the right round ligament (red arrow). (D) The other arm of the migrated IUD in the serous layer of the right anterior wall of the uterus (red arrow). (E) The tail of the migrated IUD in the right broad ligament (red arrow). (F) Complete removal of the migrated IUD (red arrow).