English

Abstract

Misplaced IUCD is the condition when the tail of IUCD is not seen through the cervical os. IUCD migration subsequent to uterine perforation is an uncommon but serious complication. Incidence of perforation varies from 1-3 per 1000 insertions.4 24 years old female, P3L2A0 with the complaints of severe dysmenorrhea for 4years and abdominal pain with low back pain for 2years. She had 2FTND and IUCD inserted 6months after last delivery in April 2007. 5months later, with 2months amenorrhea, diagnosed as pregnancy with expulsion of IUCD, as there was no thread seen through external cervical os. USG was not done. This pregnancy was terminated at 7th month due to Anencephaly in February 2008. Interval laparoscopic sterilisation done in July 2010. USG on 28/09/2013 revealed IUCD in right ovary when she went for ovum donation and advised removal. After 7.5 years, on 11/10/2013 laparoscopic removal of IUCD done from right ovary which was surrounded by adhesions and pus. Perforated site seen in the fundus of uterus as depression. Appropriate antibiotics given. Post-operative period was uneventful. On follow up, the patient is free of abdominal pain and back pain. This case report highlights the need for vigilance in misplaced IUCD. Plain X ray abdomen and pelvis can pick up the diagnosis and exclude the perforation and migration. So that further complications and morbidity are prevented. KEYWORDS; Perforation, migration, misplaced IUCD, laparoscope. INTRODUCTION: Misplaced IUCD is defined as the condition when the tail of IUCD is not seen through the cervical os2. IUCD migration subsequent to uterine perforation is an uncommon but with serious complication. Incidence of perforation varies from 1-3 per 1000 insertions.4 CASE REPORT: 24 years old female, P3L2A0 admitted with the complaints of severe dysmenorrhea for 4 years and abdominal pain with low back ache for 2 years. Menstrual cycles were regular with severe pain. She had 2FTND and IUCD inserted 6months after last delivery in April 2007. 5 months later, with 2months amenorrhea, diagnosed as pregnancy with expulsion of IUCD, as there was no thread seen through external cervical os. USG was not done. This pregnancy was terminated at 7th month due to Anencephaly in February 2008. Interval laparoscopic sterilization done in July 2010. She was suffering with lower abdominal pain for which USG done in 2012 and did not diagnose missed IUCD. USG on 28/09/2013 revealed IUCD in right ovary when she went for ovum donation and advised removal. Plain X ray abdomen and pelvis with sound insitu confirmed the diagnosis. After 71⁄2 years post insertion, laparoscopic removal of IUCD was done on 11/10/2013. IUCD was embedded in the right ovary and was surrounded by adhesions and pus. Perforated site seen in the fundus of uterus as depression. Appropriate antibiotics given. Post-operative period was uneventful. On follow up, the patient is free of abdominal pain and back pain. DOI: 10.14260/jemds/2014/2855