Laparoscopic Retrieval of Migrated IUD for a Patient with Stage Ib2 Cervical Cancer: Case Report

Abstract

To report a successfully laparoscopic retrieval of a translocated IUD for a patient with cervical cancer. Case report. University hospital Patient with cervical cancer. A 54-year-old woman (gravida 6, para 6) was referred to our department in January 2011 because of post-menopausal vaginal bleeding and abdominal pain. Pelvic examination revealed a large cervical lesion over 5 cm in greatest diameter, and biopsy analysis confirmed the moderately to poorly differentiated squamous cell cervical carcinoma. She was referred to radiation therapy as her diagnosis was FIGO stage Ib2 and she preferred radiation therapy. Pelvic magnetic resonance imaging failed because she was found to have metals in her body. A plain abdominal X-ray revealed an IUD in her pelvis. Furthermore, the IUD was found to be translocated. The migrated IUD was confirmed during CT scan which was found to be located between the tumor and rectum. An ultrasound showed an empty uterine cavity. She started her external beam radiation in January 2011. Two weeks from her initial radiation, the radiologist referred her to our clinic for the removal of IUD. Informed consent was signed. She was placed in the dorsal lithotomy position, general anesthesia was used. During laparoscopic examination, the uterus appeared normal. The IUD was located near the lower uterine segment. Half of the IUD was easily visualized, half of it submerged under the peritoneal layer, embedded in the uterine wall. The IUD was grasped; the loop was cut into two strings, and removed separately. Hemostasis was achieved by careful cautery of the peritoneal edges. The patient was discharged on postoperative day four uneventfully, and continued her radiotherapy. Translocated IUD retrieval prior to radiotherapy for patient with cervical cancer should be considered. Laparoscopy is a useful tool for the management of translocated IUD.