Introduction
intrauterine devices (IUD) are one of the most frequently used methods of contraception. Even though IUDs are effective, they can result in failure. The studies show that there is no difference between different types of IUDs in regards to complications and failure. [1-3] [4] complications include a wide range, from failures in insertion and perforation to syncope and bradycardia. since these complications are unpredictable, a clinician must always be vigilant in regards to management of adverse outcomes. [5]
IUD failures can result in pregnancy, this incidence is particularly important since they can lead to ectopic pregnancy, preterm labor and miscarriage.[1 2 6] Meanwhile, IUDs are also responsible for uterine perforation. This incidence though rare and uncommon, happens mostly during the post-partum period. [3 7]An IUD might fully or partially penetrate the uterine; as described by the Zakin et al, the most common location for a complete perforation is the pouch of Douglas.[8] It can also attach either loosely or tightly to omentum. On a rare occasion these devices can become embedded in myometrium. other cases have also reported that IUDs can migrate within abdominal cavity and can potentially cause perforations.
Although uterine perforation might even cause peritonitis and it is a potentially life-threatening incidence, it is a very rare incidence and most of times it is asymptomatic but it can manifest symptoms like abnormal uterine bleeding and pain. [9] [8] [4] [10] [11]Several imaging methods have been utilized for diagnosis but the most frequently used methods are simple pelvic radiographs and transvaginal sonography. [5] [12] [13]It has been suggested that TVS is a more accurate modality in respect to diagnosis and localization. [12 14] [5]In a previous case series, it was reported that the devices were localized with CT-scan since TVS had missed the devices particularly when the had migrated in upper abdomen. [9] [13]Depending on the location of IUD, the techniques for removal can differ and can sometimes be challenging. [12] When these devices cannot be removed at the office or when their respective location indicates surgical removal, laparoscopic surgery is the preferred method, although novel studies suggest that removal is not warranted when the patient is not symptomatic as the risks of surgery are not justifiable. [15] [5 14] [6]Deeply perforated devices can also lodge into different organs within the abdominopelvic cavity; however, the most common site is the omentum. [16] [17] [13] [10] [6] [18]
In this article, we report a 30-year-old woman on her third gravidity who had received IUD insertion 3 months prior to pregnancy and in her following work up the IUD wasn’t localized within uterine cavity. the localization and surgical removal were very challenging since the IUD was completely embedded within omentum.