Incidental Finding of Migrated Intra-Uterine Device during Elective Robotic-Assist Laparoscopic Hysterectomy

   

Cash C Sterling, Francis Lake and James Chambers*

Received: January 07,  2022 | Published: January 31, 2022

Copyright^© 2022 genesis pub by Sterling CC, et al. CC BY-NC-ND 4.0 DEED. This is an open-access article distributedunder the terms of the Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License.,This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.

DOI: https://oi.org/10.52793/ACMR.2022.3(1)-24

Abstract

Migration of Intra-uterine devices (IUDs) a rare, yet serious complication associated with a well-accepted means of contraception. IUDs have long been a safe and effective option for women of child-bearing age to prevent pregnancy. We present a 48-year-old female with known symptomatic uterine fibroids undergoing a robot-assist laparoscopic hysterectomy in the elective setting. She was found to have a previously placed IUD that migrated through her uterus and was adherent and invading into her rectum. This IUD was removed without complication and without perforation of bowel. Surgical retrieval of IUD perforation should always be considered whether symptomatic or not, to prevent serious complication. Laparoscopic removal is the option of choice, but laparotomy may be required. 

Introduction

Intra-uterine devices have been considered a first-line option for reversible contraception according to the World Health Organization (WHO). Between 2015 and 2017, over 14% of women aged 15 to 44 who used contraception chose IUDs and those numbers continue to rise. IUDs work by preventing the ovum and sperm from fertilization and are greater than 99% effective at preventing pregnancy. Migration of IUDs through the uterine wall is an infrequent complication with a reported incidence between 1.3 and 1.6 per 1000 placed.  This report describes the incidental finding, removal, and management of a migrated IUD causing serosal injury to the rectum during elective robot-assist laparoscopic hysterectomy [1-4].

Case Report

A 48-year-old Caucasian female with history of indicative uterine fibroids introduced for elective absolute stomach hysterectomy with reciprocal salpingectomy. She is G2P0-0-2-0 (AB x2) with worsening menorrhagia and dysmenorrhea described as extremely heavy and painful. She has no history of uterine masses or family history of gynecologic malignancy [5-8]. Prior pelvic ultrasonography was significant for uterine leiomyoma, but no IUD was detected. An IUD had been placed eleven years prior and was thought to be lost through vaginal migration (Figure 1,2).