Intrauterine device complications: Diagnosis and surgical management of migrated IUDs resulting in uterine and rectal perforation

Abstract

Intrauterine devices (IUDs) are widely recognized as highly effective long-term contraceptive methods, providing significant flexibility in usage duration. Available in copper and hormonal variants, IUDs have become increasingly popular due to their convenience and high efficacy rates. Despite these benefits, IUDs can occasionally result in serious complications, including septic infections and uterine perforation, which occurs at an estimated rate of 0.5–1 per 1000 insertions. Uterine perforation, if misdiagnosed, can progress to severe complications such as peritonitis and septic shock. Migrated IUDs can be located in various abdominal regions, including the Douglas pouch, broad ligament, and omentum, with rectal migration being particularly rare and challenging to diagnose and treat. We report two cases of IUD migration resulting in significant clinical presentations. The first case involves a 26-year-old female with hypothyroidism, who presented with six months of cyclic rectal bleeding following the insertion of a copper IUD. Clinical and imaging assessments revealed the IUD had perforated the uterine wall and partially migrated into the rectum. Hysteroscopic removal of the IUD was performed successfully without complications, and the patient recovered uneventfully with prophylactic antibiotic therapy. The second case describes a 30-year-old multiparous female who experienced acute pelvic pain during IUD placement. Subsequent examinations indicated the IUD had migrated into the abdominal cavity. Laparoscopic surgery identified the IUD within the omentum, and it was carefully extracted without damage to surrounding organs. The patient’s recovery was uneventful post-procedure. These cases underscore the importance of recognizing risk factors associated with uterine perforation, such as postpartum insertion and clinician experience. Migrating IUDs can present with a range of symptoms or remain asymptomatic, with diagnosis supported by ultrasound, X-ray, and CT scans. Immediate removal of the displaced IUD is generally recommended to prevent severe complications, with laparoscopy being the preferred retrieval method. The absence of IUD strings during follow-up should prompt immediate suspicion of uterine perforation, necessitating prompt multidisciplinary intervention to mitigate serious outcomes.