Case presentation
A 30-year-old woman who, based on last menstrual period, was 7 weeks and 4 days pregnant, was presented to office while complaining of abdominal pain. She stated that 3 months prior to the date she had a copper 380t IUD insertion. 2 months past insertion, in a work-up following menstrual retardation it was revealed that the patient was actually pregnant. The patient underwent ultrasonographic imaging; the live embryo with cardiac activity was observed (CRL:7.5mm). IUD wasn’t observed within the uterine cavity, no signs of uterine rupture was noted either. the IUD was seen deep within transversalis fascia and abdominal cavity. However, it was noted that the device changed position too often and it shifted from right to left, this made IUD nearly impossible to be precisely located. According to the fact that the patient suffered from pain and was symptomatic the patient became a candid for laparoscopic surgery. Unfortunately, during the surgery, the device wasn’t found and it was assumed that the initial ultrasound imaging was false and the device was still entrapped within myometrium. Another ultrasonography stated the device was actually within the abdominal cavity and it might be trapped inside omentum since it shifted as the patient changed position. since the first diagnostic evaluation couldn’t locate and find the device it was decided that the device should be removed under ultrasonographic guidance. Prior to spinal anesthesia, the radiologist ran another ultrasonographic imaging using a superficial ultrasound probe. The location was then marked. (Figure 1) During the second laparotomy a paraumbilical incision was made and the device was found with the guidance and palpation as the device was barely visible and the threads were twisted inside the omentum. The foreign body had migrated into the omentum and was embedded into it. Granulation tissue was also formed around it which made it very difficult to distinguish. We performed partial omentectomy and the device was safely removed. (Figure 2 and 3) The patient was under observe for 24 hours, another ultrasonography assessed fetal cardiac activity and status. The patient was later discharged without any major complications.
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