The intrauterine contraceptive device (IUCD) is a long-acting reversible contraceptive device. Worldwide, it is a mainstay of family planning. Although IUCD use offers the benefits of being low in cost, long lasting, highly effective, and reversible. It is not risk free. The migrated IUCD can cause fibrosis, perforation and obstruction of the large and small bowel, mesenteric penetration, bowel infarction, rectal strictures, and rectouterine fistula.
Most IUCD perforations occur at the time of insertion. Perforation is most commonly seen through the posterior wall of the uterus. Most of these perforations are asymptomatic and therefore go unrecognized until follow-up examinations are performed or they become symptomatic. Gastrointestinal symptoms can be observed, especially when the device migrates intraperitoneal.
A 33-year-old lactating woman, gravida 4, para 4, presented to our surgical clinic for pain in right iliac fossa, nausea and vomiting with one week history of placement of copper-T by Lady Heath Visitor. Mild tenderness in right iliac fossa . During vaginal examination, the strings of the IUCD were not found. Transvaginal ultrasonography (choice of investigation) did not show any sign of the IUCD inside the uterus, and this led to a subsequent abdominal radiograph, on which the IUCD was noted in the upper pelvis, suggestive of migration.
The patient was scheduled to undergo a diagnostic laparoscopy to look for an intraperitoneal IUCD. At the time of surgery, the IUCD was noted in right adnexa, strings coming out with manipulation of uterus. The uterus and adnexa were normal. The IUCD was successfully removed from 10 mm port.
The World Health Organization recommended that displaced IUCDs should always be removed to prevent possible complications that can occur due to intraperitoneal adhesion formation or migration into adjacent organs.
In summary, a migrated IUCD should be removed when the diagnosis is made. This generally can be performed laparoscopically.
