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.
(Figure1)
(Figure2)
(Figure3)