International Journal of Clinical Case Reports 2015, Vol.5, No. 38, 1-3
3
examination as in our case. CT scan be of benefit in
locating the area of migration (Oxby et al., 2006),
however endoscopic surgery e.g. laparoscopy, cystoscopy,
colonoscopy, remains the ultimate diagnostic and
management tool (Mulayim et al., 2006).
It is a general consensus that surgical removal of migrated
IUCD for symptomatic patient must be performed but
surgical removal on asymptomatic patients remains
controversial. Reports have suggested patient may benefit
from conservative management however only restricted to
those where migration did not perforate adjacent organs
such as bowels and bladder (Markovitch et al., 2002)
while traditionally, the World Health Organisation
(WHO) in 2002 recommended a displaced IUD should
always be removed.
Once the exact location of the IUCD can be deduced and
the decision of surgical removal is made, it is important to
plan the surgery as part of a multidisplinary team
involving the necessary specialties such as surgeons or
urologist. Potential complication during removal such as
organ perforation (e.g. bowel, bladder) and potential
surgery such as resection of bowel and stoma insertion
should be discussed in advance. As a result, all
diagnosis and treatment can be performed at the same
setting as it has been demonstrated in our case.
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.
Conflict of interest statement: We declare that we have
no conflict of interest to disclose.
Reference
Darlong L., Panda S., Topnor N., and Hajong R., 2009, Colonoscopic
retrieval of migrated copper-T, Journal of Minimal Access Surgery, 5.2:
40-42
Intrauterine Contraception, Faculty of sexual and reproductive healthcare
clinical guidance Nov 2007
Katara A., Chandiramani V., Pandya S., and Nair N., 2004, Migration of
intrauterine contraceptive device into the appendix, Indian Journal of
Surgery, 66(3): 179-180
Kulier R., O’Brien P.A., Helmershorst F.M., et al., 2007, Copper containing,
framed intra-uterine devices for contraception, Cochrane Database of
Systematic Reviews, Issue 4
Markovitch O., Klein Z., Gidoni Y. et al., 2002, Extrauterine mislocated
IUD: is surgical removal mandatory? Contraception, 66: 105-108
Mulayim B., Mulayim S., and Nilufer Y.C., 2006, A lost intrauterine device,
Guess where we found it and how it happened, European Journal of
Contraception and Reproductive Health Care, 11.1: 47-49
Oxby C., Jones S., and Acharya S., 2006, Perforation of the bowel from
intrauterine contraceptive devices: case series and solution, Gynecol.
Surg. 3: 215-217
Qublan H.S., and Dabbas M.A., 2002, Misplacement of an intrauterine
contraceptive device into the ureter after uterine wall perforation, BJU
International,90(1):135-136
Wei T.Y., Hsieh C.C., and Lo T.S., 2003, Case report intravesical migration
of an intrauterine device with stone formation, AZ J Obstet Gynecol,
43(5): 391-392
