Missed Diagnosis of Perforation and Intraperitoneal Migration of an Intrauterine Device and Its Management in a Resource-Limited Setting: A Case Report

Abstract

Background

The intrauterine device is a popular and highly effective form of long-acting reversible contraception. Although generally safe, complications could happen. One of the most serious complications of intrauterine device use is uterine perforation. Risk factors for perforation include, but are not limited to, postpartum period, breastfeeding, levels of experience, and excessive force exerted during insertion. This case is significant because it demonstrates risk factors for uterine perforation, how to handle missing strings, and care in places with little resources.

Case Presentation

We discuss the case of a 27-year-old black Ethiopian woman who presented with chronic pelvic pain and had a perforated intrauterine device discovered in the cul-de-sac. The device had been inserted at six weeks postpartum. The client was unable to feel the strings three months after insertion, and a wrong diagnosis of expulsion was made. After one year of insertion, the intrauterine device was located on a plain abdominal radiograph and removed via laparotomy without complications.

Conclusion

Although uterine perforation is a rare complication of intrauterine device insertion, special attention should be paid to women with risk factors. In the absence of a witnessed expulsion, assessments and investigations should be carried out before declaring a device expelled. In patients with chronic pelvic pain complaints in the presence of an intrauterine device, perforation and migration outside the uterine cavity should be considered. Abdominal X-rays and laparotomies can be used to find and manage extrauterine migrating devices in environments with limited resources.

Keywords:

• intrauterine device
• missed uterine perforation
• intraperitoneal migration

Abbreviations

BMI, Body Mass Index; CU-IUD, Copper coated Intra Uterine Device; IUS, Intrauterine System; PID, Pelvic Inflammatory Disease; WHO, World Health Organization.

Ethics Approval and Consent to Participate

Not applicable. Our institution does not require an approval for publication of case reports.

Consent for Publication

Written informed consent for publication of their clinical details and images was obtained from the patient. A copy of the written consent is available for review by the Editor-in-chief of this journal.

Acknowledgments

The author would like to thank the Department of Obstetrics and Gynecology at Saint Peters Specialized Hospital, Addis Ababa, Ethiopia.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests for this work.

Additional information

Funding

This research did not receive any funding from public, commercial, or other funding agencies.