Ileal penetration by a Multiload-Cu 375 intrauterine contraceptive device. A case report with review of the literature

Abstract

A case of a 28-year-old gravida 3 para 2 woman with an ileal penetration by an intrauterine device (IUD) is reported. Four weeks following insertion of a Multiload-Cu 375, the woman underwent laparotomy due to persistent vague abdominal pain and translocation of the IUD. The device had perforated the fundal uterine wall and the two flexible side arms and the copper-bearing rod had completely eroded into the wall of the ileum with only the strings protruding outside the small bowel mesentery. Resection of an ileal segment with end-to-end anastomosis was performed. The woman made an uneventful recovery. It appears that a translocated Multiload-Cu 375 IUD body can penetrate and be entirely embedded within the bowel wall as early as 4 weeks following translocation. This report documents the shortest interval between insertion and proven bowel injury by an IUD.

PIP: The frequency of IUD-associated uterine perforation has been estimated at 0.05-13.0/1000 insertions; 15% of such perforations lead to complications in the adjacent visceral organs, primarily the intestines. This paper describes the case of a 28-year-old gravida 3, para 2 woman with an ileal perforation associated with insertion of a Multiload-Cu 375 IUD at the 3-month postpartum visit. The insertion was noted to be difficult and painful. The woman presented to the clinic 25 days after insertion with abdominal pain and missing IUD strings. The IUD had perforated the full thickness of the anterior fundal uterine wall. The two flexible plastic arms and the vertical copper-bearing limb had completely eroded into the wall of the ileum. Resection of an ileal segment with end-to-end anastomosis was successful. The literature on IUD-related perforations--summarized in a table accompanying this article--reveals a median time interval of 17 months (range, 2 months to 13 years) post-insertion. Thus, the present case represents the shortest documented interval (4 weeks) between IUD insertion and proven bowel injury.