Laparoscopic Removal of Migrated Intrauterine Device Embedded in Intestine

Abstract

Introduction:The intrauterine device (IUD) is a popular family planning method worldwide. Some of the complications associated with insertion of an IUD are well described in the literature. The frequency of IUD perforation is estimated to be between 0.05 and 13 per 1000 insertions. There are many reports of migrated intrauterine devices, but far fewer reports of IUDs which have penetrated into the small intestine.Case Description:Herein we report a case of perforated intrauterine device embedded in the small intestine. By using a wound protector retraction device, and fashioning the anastomosis extra-corporeally, we were able to more easily perform this laparoscopically. This left the patient with a quicker recovery, and a better cosmetic result.Discussion:IUD perforation into the peritoneal cavity is a known complication, and necessitates close follow-up. Most, if not all, should be removed at the time of diagnosis. In the majority of previously reported cases, removal was done through laparotomy. Even in cases where removal was attempted laparoscopically, many were later converted to laparotomy. Surgeons should be aware of different techniques, including using a wound protector retraction device, in order to facilitate laparoscopic removal.

Intrauterine contraceptive device perforating the cecum, a pregnancy complication?

“…[6] Complete perforation can result in migration of the IUCD to other intra-abdominal structures, such as the ureter, urinary bladder, omentum, small intestine, appendix, sigmoid colon, as well the cecum in this case. [45] Literature shows few similar cases although with two major differences. First of which, the IUCD was penetrating the cecal wall associated with an inflamed appendix and was managed by appendectomy.…”

“…There are some reported cases of a migrated IUCD in the ureter, urinary bladder, omentum, small intestine, appendix, and sigmoid colon. [45] We herein report a case of a cecal perforation by a copper T 380A IUCD, which is suggested to have occurred during pregnancy, a case that was managed laparoscopically.…”

Migration of intra caesarean intrauterine device to sigmoid colon: a case report

“…Management of migrated IUD in an asymptomatic patient is controversial, but experts suggest that all extra uterine devices should be removed irrespective of the location and type of IUD. 11 Retrieval of misplaced IUD can be done by laparoscopy or laparotomy. Laparotomy is necessary if the device is embedded in the viscera or bound by adhesions.…”

Laparoscopic removal of migrated intrauterine device

“…Currently, however, experts advised that perforated IUDs should be removed immediately due to potential for fibrosis and bowel perforation 2. The omentum (26.7%), pouch of Douglas (21.5%) and colonic lumen secondary to perforation (10.4%) were the most common sites where IUDs were found 4. Laparoscopic removal is the most common method, but it has its limitations.…”

“…Laparoscopic removal is the most common method, but it has its limitations. In systematic review by Gill et al , 179 cases documented in literature that highlight IUD removal via laparoscopy, 64.2% were successfully completed without conversion to laparotomy 4. Adhesions and bowel perforation were correlated with higher rates of failure, and conversion to laparotomy.…”