Laparoscopic retrieval of intrauterine device perforating the sigmoid colon

Abstract

Introduction: The intrauterine device (IUD) is a well-tolerated, widely used contraceptive. A major but infrequent complication of the IUD is perforation of the uterus or cervix and migration of the device into the abdomen. Our case of laparoscopic retrieval of an IUD perforating the sigmoid colon illustrates this rare complication.

Methods: A 36-year-old woman with a history of IUD placement 4 years earlier presented with complaints of abdominal pain and bright red blood per rectum. She had conceived 9 months after IUD placement and suffered a spontaneous abortion requiring an evacuation of the retained products of conception. At presentation, she was afebrile with normal vital signs. Physical examination was significant for tenderness to palpation over the left lower quadrant.

Results: Computed tomography (CT) scans of the abdomen and pelvis showed a foreign body through the wall of the uterus and entering the colon. Colonoscopy revealed an IUD penetrating the sigmoid wall, and multiple failed attempts were made to remove the IUD colonoscopically. Diagnostic laparoscopy was performed that revealed an IUD perforating the uterus and entering the sigmoid. The IUD was manipulated free and removed, and a suture closed the sigmoid defect. The patient was discharged home on the first postoperative day without complication.

Conclusions: The IUD is one of the most effective, safe, and economic contraceptive methods. Uterine perforation and intraperitoneal translocation is an unusual complication of an IUD. Perforation of hollow viscous is likely even less common. Confirmation of a "missing" IUD is mandatory if pregnancy occurs after IUD placement. Removal of a translocated IUD is recommended, and operative laparoscopy is the preferred method.

Figures

Figure 1.

Computed tomographic scan of the abdomen and pelvis showed a foreign body invading the posterior wall of the uterus and entering the colon.

Figure 2.

Colonoscopy revealing an IUD penetrating the sigmoid wall with surrounding granulation tissue.

Figure 3.

Laparoscopy showing an IUD perforating the uterus and entering the sigmoid.

Figure 4.

Laparoscopy showing an IUD perforating the uterus and entering the sigmoid.