Combined Management of a Rare Case of an Incarcerated Intrauterine Device: Case Report and Review of the Literature.

Abstract

Background: Hormonal intrauterine systems are widely used for long-acting reversible contraception and for managing gynecological conditions such as heavy menstrual bleeding and endometrial hyperplasia. Although rare, complications such as uterine embedment and perforation can occur, potentially leading to device malfunction or injury displacement. This is the first reported case describing the removal of a fully incarcerated hormonal intrauterine system using a combined hysteroscopic and laparoscopic approach. Our findings suggest that this technique may offer a safe and effective alternative for managing cases of embedded intrauterine devices where conventional hysteroscopic removal is unsuccessful.

Case presentation: We report the case of a 35-year-old asymptomatic woman with a hormonal intrauterine system fully embedded in the posterior myometrial wall, positioned 4.3 mm from the uterine serosa. The device was initially confirmed to be intracavitary upon insertion but was later found to have migrated into the myometrium during a routine 30-day follow-up ultrasound. Initial attempts at hysteroscopic removal failed due to poor visualization and a broken retrieval string. Given the high risk of iatrogenic injury, a combined laparoscopic-hysteroscopic approach was planned. Under laparoscopic visualization and transrectal ultrasound guidance, a careful myometrial excision using a hysteroscopic-angled loop was performed, successfully freeing and removing the intrauterine device. A bilateral salpingectomy was also conducted at the patient's request.

Conclusion: A combined laparoscopic-hysteroscopic approach under ultrasound guidance may be regarded as a viable technique for complex cases of intrauterine device incarceration within the myometrium, minimizing the risk of uterine perforation and adjacent organ injury.