1652 Missing Intrauterine Device Rediscovered in a Sigmoid Colon Polyp Nearly a Decade After Insertion

Abstract

INTRODUCTION: Intrauterine devices (IUD) are a popular form of contraception with an overall low risk of complications. We report a patient with an IUD placed 8 years ago with the rare incidence of asymptomatic migration into a sigmoid polyp discovered with colonic rectal ultrasound requiring surgical removal. CASE DESCRIPTION/METHODS: A 50-year-old gravida 5 para 5 female presented with right lower quadrant pain for 1 week. Pain described as intermittent and radiating to her right flank. Last menstrual period was 3 weeks prior to presentation. She denied any fever, nausea, vomiting, vaginal bleeding, hematochezia or melena. History included IUD placement 8 years ago, nevertheless became pregnant. At that time, patient was informed her IUD had fallen out and proceeded with tubal ligation postpartum. Labs were within normal limits with a negative urine analysis and pregnancy test. Computed tomography of the abdomen/pelvis demonstrated translocation of IUD to the sigmoid colon wall. Gastroenterology performed a colonoscopy with rectal ultrasound that confirmed a metallic object in a sigmoid colonic polypoid lesion. Subsequently, general surgery performed a robotic assisted laparoscopic sigmoid colon resection. Her abdominal pain subsidized and patient was discharged home in stable condition. DISCUSSION: Uterine perforation and migration into abdominopelvic structures is a known, but rare complication to IUD usage, at a rate of less than 1 per 1000 applications. Perforation generally occurs during IUD insertion and risk factors include anatomically flexed uterus, clinician inexperience, and placement postpartum when the uterus is relatively thin walled. Many cases of perforation are asymptomatic and not discovered until years later. However, relatively few cases in the literature describe perforation with migration into the sigmoid colon. Reported cases describe IUDs placed postpartum becoming embedded in the uterus, with subsequent pregnancy, and uterine contractions forcing the IUD through the uterine wall and into the pelvic cavity. Treatment typically involves endoscopic foreign body retrieval. However, cases at high risk for bleeding or endoscopic limitations require surgical laparoscopy for safe removal. We highlight the utility of colonic ultrasound as safe and minimally invasive procedure to establish the diagnosis. While typically asymptomatic, migrated IUDs are a serious complication that can be diagnosed through computed tomography or colonic ultrasound requiring prompt foreign body removal.