Intravesical migration of an intrauterine device detected in a pregnant woman

Abstract

The intrauterine device (IUD) is common method of contraception among women because of its low cost and high efficacy. Perforations are possible; most perforations occur at the time of insertion, yet the complication can occur with a previously inserted IUD. Perforation of the bladder by an IUD is extremely rare. In this report, we present a case in which the IUD perforated the uterus and migrated to the bladder. At the time of the diagnosis, the patient was 8 weeks pregnant.

Intravesical Migration of Intrauterine Device Mimicking Bladder Stone on Radiologic Imaging: A Case Report

“…Uterine perforation rates were reported between 1/2500 and 1/350 in various studies [1,2,4,5]. However, the true incidence might be higher because of unreported asymptomatic cases [6]. Migration to the bladder and calculus formation are very rare [2].…”

“…Spontaneous migration of IUD has been tried to be explained by several mechanisms such as iatrogenic perforation of the uterus, spontaneous uterine or involuntary bladder contractions, intestinal peristalsis, and peritoneal fluid motion [1,5,6]. Among the factors that increase the risk of uterine perforation are IUD application by inexperienced medical practitioners, uterine wall fragility related to multiparty, uterine atrophy, hypoestrogenemia during postpartum and lactation periods, adhesions due to previous operations, vaginal tissue damage created by speculum, history of a recent abortion, and congenital uterine anomalies [1][2][3]6].…”

“…Among the factors that increase the risk of uterine perforation are IUD application by inexperienced medical practitioners, uterine wall fragility related to multiparty, uterine atrophy, hypoestrogenemia during postpartum and lactation periods, adhesions due to previous operations, vaginal tissue damage created by speculum, history of a recent abortion, and congenital uterine anomalies [1][2][3]6]. Although uterine perforation usually occurs at the time of insertion, migration to the bladder and development of symptoms are slow processes [2].…”

“…Late appearance of symptoms suggested that perforation did not occur at the time of insertion, but this might be due to slow progression of migration. Many authors have emphasized that application of IUD by experts had the primary importance to prevent complications [1,6]. Postponement of early postpartum IUD insertions for 3 months has been also highlighted as a precaution [6].…”

“…Intravesical migration of IUD might result in calculus formation. A clinical scenario of a vanishing IUD in conjunction with bladder stone should suspect an encrusted intravesical IUD [6].…”