Misplaced Intra Uterine Contraceptive Device presenting as strings at anus

Abstract

Contraception is essential esepcially for developing and highly populated country like India. Intrauterine contraceptive device (IUCD) is one of the most frequently used method. Various complications of IUCD has been described. Here, we are reporting an unusual case in which the IUCD migrated to rectum. CASE REPORT A 33 year Para 4+0 women presented with feeling of some strings at anus without any other complaints. She had Copper T IUCD insertion four years ago. Per vaginal examination was normal and black strings were seen protruding out of the anus (Figure 1). On proctoscopy these strings were visible but upper limit was not seen (Figure 2). On plain X ray abdomen, the copper T IUCD was found to be extra uterine (Figure 3). This misplaced device was removed with gentle traction by per-rectal route (Figure 4). The woman was advised to take contraceptive pills as an alternative method of contraception. Figure 1 Figure 1: Strings peeping out of anus Figure 2 Figure 2: Proctoscopic Examination Misplaced Intra Uterine Contraceptive Device presenting as strings at anus 2 of 3 Figure 3 Figure 3: Plain X ray showing Copper T at recto-sigmoid Junction Figure 4 Figure 4: Extracted Copper T DISCUSSION Contraception is essential especially in a country like India. Insertion of IUCD is safe and effective tool for unwanted pregnancies but it may be associated with some unwanted complications. Perforation of the uterus by an IUCD is a serious complication occurring in 1/350 to 1/2500 insertions1. An IUCD may perforate through the uterine wall into the pelvic or abdominal cavity or into adjacent organs like sigmoid colon, rectum and even may cause appendicular perforation2. Finding strings of IUCD at anus is very rare and only one case has been reported in world literature like our case3. Ultrasonography is a convenient, safe and noninvasive method of locating an IUCD within the uterine cavity and thereby assessing correct placement. For localization of lost IUCD ultrasound, X-ray may be needed1. In lost IUCD rectal examination should be always kept in mind. When an IUD is located in the abdominal cavity, it should be removed, even in an asymptomatic patient4. The probable route of travel of the IUCD was perforation of uterus and rectal wall. So digital rectal examination is of great value in locating the IUCD in rectum or anus4.