Extrauterine Displaced Intrauterine Devices: When Should They Be Surgically Removed?

Abstract

Use of the intrauterine device (IUD) is widely accepted as a contraceptive method throughout the world because of its safety, economy, efficiency, and reversibility. However, IUD use is associated with rare side effects and complications, such as irregular menstrual bleeding, dysmenorrhea, pelvic infections, expulsion of the device, and uterine perforation. Uterine perforation is a rare but serious complication that generally occurs during insertion of the device, but may also occur as a result of migration of the IUD through the uterine wall. Expulsion and dislocation of the IUD may lead to pregnancy; however, pregnancy can still occur even when the IUD remains in utero, and its efficacy has been demonstrated to be about 97% [1]. Displaced IUDs are associated with potential risks to the adjacent organs, such as the bowel or bladder, and might also lead to pelvic infections and abscesses. The management of extrauterine displaced IUDs still remains controversial, and no consensus opinion exists. In this case report, a patient presented with an undesired pregnancy and a displaced IUD, which was located within a pelvic abscess in the Douglas pouch. The management of extrauterine displaced IUDs is also discussed. A 28-year-old woman had an undesired pregnancy with a displaced IUD, which was found within a pelvic abscess in the Douglas pouch. She was referred to our clinic, complaining of pelvic pain, fever, fatigue, nausea, vomiting and missed menstrual period. She had a history of IUD insertion 4 years ago and no history of previous pelvic inflammatory disease or sexually transmitted disease. Her menstrual periods were regular. Her inflammation markers were as follows: C-reactive protein was 50 mg/L, and leukocyte count was 15,000/μL.