A new technique for the removal of a transmigrated intrauterine device with rectum penetration

Abstract

rectal examination. Colonoscopy revealed that the transverse arms and a part of the horizontal arm of the IUD had penetrated the rectum at 10 cm with protruding strings in the lumen (Figure 2). Retrieval of the IUD by pulling on the threads was attempted but unsuccessful, as the IUD was firmly adherent to the colon wall. Because pulling the strings vigorously to remove the IUD could have resulted in intestinal defects that may have required surgical repair, we decided to remove the IUD by applying traction force. A rubber band was fastened to the strings of the IUD and was stretched by pulling it thorough the anus where the free end of the rubber band was fixed to the buttocks with adhesive tape (Figure 3). The patient was called, and traction applied by the rubber band was checked every other day. On day 4 of the procedure, the IUD was expelled. The area in which the IUD had been embedded was clear.The present case report describes a rectal transmigration of an IUD and its endoscopic removal using a rubber band traction technique without the need for surgery. IUDs are among the most common reversible methods of contraception worldwide. Uterine perforation is the most serious complication associated with IUD insertion, with an estimated incidence of 0 to 10 perforations per 1,000 insertions. Perforations commonly occur at the time of insertion or shortly thereafter, but may also occur many years later. Although the exact mechanism of IUD transmigration accompanied by uterine perforation is not known, the most important risk factors are the skill of the operator; the features of the IUD; the size, shape, and configuration of the uterus; past operations; and timing of insertion after delivery. In the present case, uterine abnormalities were not detected, and there was no previous operation history (3-5).It should be noted that the majority of uterine perforations do not affect other organs; however, 15% of cases lead to complications in adjacent organs, specifically the intestine. Intestinal complications caused by IUD migration include obstruction, infarction, perforation, fistula formation, and mesenteric injury. Penetration of the intestine by an IUD occurs most commonly in the sigmoid colon (40.4%), followed by the small intestine (21.3%) and rectum (21.3%). Patients presenting with uterine perforation may experience pelvic pain, excessive bleeding, and fever; however, migration may be asymptomatic in approximately one-third of patients. The triad of symptoms most often experienced by women with intestinal injuries includes chronic abdominal pain, fever, and intermittent diarrhea. In the present case, however, the patient complained of feeling strings near her anus (6-8).The diagnosis of a transmigrated or dislocated IUD is made by clinical, radiological, and ultrasonographic examination. However, pregnancy should be ruled out before any diagnostic procedure. Other examinations, including hysterography, hysteroscopy, colonoscopy, and laparoscopy, should also be performed as needed. Despite the presence of an I...

Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon

“…A few reports have been published on the sigmoidoscopic or colonoscopic removal of an IUD perforated into the colon [ 6 - 9 ]. When the IUD is located within the colon wall, colonoscopy is useful for removing the IUD, and most patients do not develop peritonitis after removal of an IUD by using colonoscopy.…”

“…The possible ways of removing a perforating IUD have been gradually increasing in number due to the development of endoscopic instruments and techniques. Reports have been published on the successful endoscopic removal of an IUD by using a needle knife sphincterotomy of an IUD embedded in the colon wall or by a gradual pulling of an IUD fixed in the rectum by using a rubber band through the endoscope [ 8 , 9 ]. However, when the device is firmly embedded in adjacent structures, colonoscopic removal is not suitable.…”

Migration of intrauterine devices into the gastrointestinal tract

“…Laparoscopia poate fi ineficientă în caz de aderențe multiple sau inflamație locală intensă; în aceste cazuri fiind necesară conversia [5,22,27]. În unele situații, cum ar fi în perforație gastrointestinală complicată cu peritonită, ocluzie intestinală, diagnosticarea unui abces intraperitoneal sau fistulei intestinale se recomandă imediat laparotomia pentru a îndepărta dispozitivul și pentru a rezolva leziunile locale [7, 26,48,49].…”