Sigmoid Colon Migration of an Intrauterine Device

Abstract

Background. Intrauterine devices (IUD) are commonly used birth control methods. Colonic perforation is an infrequent but serious complication of IUD. Case. A 34-year-old woman with 2-years history of IUD, inserted at early puerperal period, presented to gynecologist with chronic pelvic pain and dyspareunia. Radiological assessment revealed that there were two copper-T devices: one in uterine cavity and another in the colonic lumen. Attempts of retrieval with colonoscopy and laparoscopy were unsuccessful. Intrauterine device embedded in sigmoid colon wall was removed with resection of the involved segment and primary anastomosis was performed. Conclusion. Although there are cases in literature that are successfully managed with colonoscopy, in chronic cases, formation of granulation tissue complicates retrieval of an IUD by this intervention.

Endoscopic removal of an incidentally discovered intrauterine contraceptive device eroding into the rectum

“…There are about 30 case reports of colorectal erosions by migrated IUCDs over the past 10 years. The sigmoid colon is more commonly affected than any other parts of the colorectum 10–12. Our search revealed that the sigmoid colon was involved in 60% of the reported colorectal cases penetrated by migrating IUCDs.…”

“…The other two cases presented with pelvic pain, dyspareunia and vaginal/rectal bleeding. In both cases, the missed IUCDs were found penetrating the sigmoid colon 12 13. One of them had failed attempts at endoscopic and laparoscopic retrievals and was therefore treated by open resection and primary anastomosis 12.…”

“…This emphasises the importance of performing the appropriate imaging such as anteroposterior X-rays and pelvic ultrasonography before assuming ‘spontaneous’ expulsion of a missing IUCD. Review of the literature revealed only three similar cases in which two IUCDs were discovered at the time of presentation 12–14. One case was that of a 77-year-old woman who was found during routine colonoscopy for iron-deficiency anaemia to have one IUCD penetrating the transverse colon and the other was eroding into the rectum 14.…”

A Rare Cause of Colon Perforation; Intrauterin Device

“…The using rate of IUD as a contraceptive method in developed countries is 9.4% and 16.4% in undeveloped countries (5). In recent years, use of IUD has decreased with the belief that it increases the risk of infection (6).…”

Incidental detection of intrauterine device in sigmoid colon and its removal with colonoscopy

“…Although there are studies suggesting that highrisk and asymptomatic patients may be followed up with medical treatment, in case of perforations or migration to intestine, bladder or vessels, IUD should be removed 3,6 . The primarily preferred treatment should be laparoscopic methods for IUDs which were detected to cause perforation of myometrium or abdomen by radiological examinations and laparotomy can be performed if laparoscopy fails because of extensive adhesions 7,8 . The cases who were treated with endoscopic treatment instead of surgical treatment in case of migration of IUD to colon were reported in the literature .…”