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.