Perforation of the appendix and the sigmoid colon by an ectopic IUD

Missing intrauterine device migrated to terminal ileum resembling adnexal mass: A case report

“…While the migrating IUD can be found anywhere in peritoneal cavity, or embedded in abdominal viscera like the mesentery, small and large intestine, or even the appendix, the most common site of involvement reported has been sigmoid colon, followed by small intestine and rectum respectively [ [7] , [8] , [9] ]. Some cases were asymptomatic [ [9] , [10] , [11] , [12] , [13] ], while others presented with symptoms from pelvic pressure and mild dull aching pain to chronic pelvic pain and lower abdominal pain, dysmenorrhea and abnormal vaginal bleeding, dyspareunia and back pain [ [6] , [7] , [8] , [14] , [15] , [16] , [17] ]. Some patients presented with symptoms like epigastric discomfort and hematochezia [ 4 , 18 ].…”

An Interesting Image of Transmural Migration of a Levonorgestrel-Releasing Intrauterine Device (LNg-IUD)

“…According to Chai et al, two devices encountered in the same patient were described as migrating devices, the second one being inserted during a cesarean section procedure, both exceeding the uterine serosa and discovered on CT scan, the second one being inserted after considering the first one, erroneously, “lost” [ 5 ]; this incident draws attention to the importance of an accurate diagnosis before making a decision to mount another intrauterine device. As in our patient’s case, migration of the IUD can occur over time as a distant migration, a result of gradual erosion of the myometrium [ 2 , 3 ], or it can occur immediately after insertion, this phenomenon being encountered in the immediate postpartum period. According to World Health Organization (WHO) recommendations, the indicated treatment is extraction of the IUD, as soon as possible; if we are not able to retrieve the device, a laparoscopy should be considered [ 6 , 7 , 8 , 9 , 10 ].…”

“…Another complication described was related to an intrauterine device identified within an ovarian tumor, in a 63-year-old patient, without a clear explanation as to whether the tumor was a consequence of the migration of the IUD inside the ovary or its development was concomitant [ 1 ]. The mechanism of migration remains unknown [ 1 ], but uterine contractions are thought to play a role [ 2 , 3 , 4 ]. According to Chai et al, two devices encountered in the same patient were described as migrating devices, the second one being inserted during a cesarean section procedure, both exceeding the uterine serosa and discovered on CT scan, the second one being inserted after considering the first one, erroneously, “lost” [ 5 ]; this incident draws attention to the importance of an accurate diagnosis before making a decision to mount another intrauterine device.…”

“…According to World Health Organization (WHO) recommendations, the indicated treatment is extraction of the IUD, as soon as possible; if we are not able to retrieve the device, a laparoscopy should be considered [ 6 , 7 , 8 , 9 , 10 ]. Laparotomy should remain the optimal option for most of the complicated cases [ 3 ]. In case of migration in areas such as the rectosigmoid, the colon, or the urinary bladder, other minimally invasive methods should be considered, such as colonoscopy and cystoscopy, as more appropriate [ 11 , 12 , 13 , 14 , 15 ].…”