International Journal of Clinical Case Reports 2015, Vol.5, No. 38, 1-3
1
A Letter Open Access
Case Report: a Case of Migrated Intrauterine Copper Device into the Rectum
Successfully Managed as a Multidisciplinary Approach after 2 Years of Insertion
Li K.E., Matsuzono T., Lee M.H.M.
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong
Corresponding author email
International Journal of Clinical Case Reports, 2015, Vol.5, No.38 doi: 10.5376/ijccr.2015.05.0038
Received: 15 Jul., 2015
Accepted: 16 Aug., 2015
Published: 21 Sep., 2015
Copyright
©
2015 Li et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Li K.E., Matsuzono T., Lee M.H.M., 2015, Case Report: a Case of Migrated Intrauterine Copper Device into the Rectum Successfully Managed as a
Multidisciplinary Approach after 2 Years of Insertion, International Journal of Clinical Case Reports, 5(38) 1
-
3 (doi
Abstract
Objective
:
We present a case of migrated IUCD into the rectum 2 years after its insertion.
Case:
A 34 years old lady suffers from a migrated intrauterine copper device (MLZ380) into the rectum despite being asymptomatic
for 2 years. Diagnosis was made by a combination of x rays, ultrasound and laparoscopy. Successful removal was performed by a
multidisciplinary effort through diagnostic laparoscopy, colonoscopy and anterior resection of bowel in the same settings.
Conclusion:
Our case demonstrated a migrated IUCD can have its large proportion migrated into the rectal cavity while despite
rectal perforation, it can remain relatively asymptomatic for over 2 years. Removal of such migration often require detail
investigations and multi-disciplinary involvement to ensure safe removal and in a single operative occurrence.
Keywords
Contraception; Intrauterine device
Introduction
Intrauterine contraceptive devices (IUCD) are
effective, safe and economic methods of contraception.
Perforation of the uterus is infrequent and migration of
IUCD was reported as 2.3/1 000 insertions (Intrauterine
Contraception, 2007). Recognition of perforation and
subsequent migration may present after several years
of symptom free period. Diagnosis and management
often require several modalities and several surgical
specialties. We report a case of IUCD partially
migrated into the lumen of the rectum 2 years after its
insertion and removal was performed in a single
operative episode involving both gynaecologists
and surgeons.
Case
A 34 years old fit and well lady who previously had a
single normal vaginal delivery 15 years ago had her
intrauterine copper device (IUCD) (MLZ380) inserted
for contraception in the family planning clinic 2 years
before she was first seen. The insertion was claimed
uneventful and she had no particular problems after
insertion. She has been having unprotected contraception
without being pregnant. One year after the IUCD
insertion, patient went to the PAP cervical smear clinic.
Unfortunately no coil thread was seen. Immediate
ultrasonography failed to locate intrauterine coil but
an abdominal x ray showed IUCD in pelvis (Figure 1a
and 1b).
On her first encounter with our department, she was
complaining of occasional lower abdominal discomfort
with the translocated IUCD but otherwise well. She
was free from any bowel or urinary symptoms and
had no problems with sexual intercourse or vaginal
discharge. Abdominal examination and vaginal
examination were unremarkable. Gentle per rectum
examination did not show any obvious signs of the
IUCD. Vaginal USG and X rays were repeated
confirming the diagnosis of translocated IUCD.
Meanwhile patient was put on oral combined contraceptive
pills for additional contraceptive method.
Figure 1a Abdominal X ray and KUB of migrated IUCD
