ANNALS OF IBADAN POSTGRADUATE MEDICINE
CASE REPORT: RETRIEVAL OF AN INTRA-UTERINE CONTRACEPTIVE DEVICE PENETRATING THROUGH THE WALL OF THE RECTUM
O.O Bello1 , O.O Ayandipo2 , and R.O Olayide1
A Copper T intrauterine contraceptive device (IUCD) is a commonly employed method of reversible contraception for women. Its use has been associated with complications such as bleeding, perforation and migration to adjacent organs or peritoneum. Uterine wall erosion and subsequent perforation by an IUCD is not unusual; however the subsequent intraperitoneal migration, to and perforation of the rectum is uncommon. We present a case of 31-year-old female with an IUCD migrating through the uterus possibly into the peritoneal cavity and subsequently eroding into the posterior rectal wall. It was removed easily without complications through the rectum during an examination under anesthesia.
Keywords: Intrauterine contraceptive device, perforation, migration, rectum.
Dr. O.O. Bello
Dept. of Obstetrics and Gynecology,
University College Hospital,
Intrauterine contraception as a form of contraception is a popular choice amongst women seeking long-term pregnancy prevention. The intrauterine contraceptive devices (IUCDs) are safe and highly effective reversible contraceptives that are also economical 1,2 . Complications like displacement, embedment, expulsion and perforation are often associated with malpositioning of IUCD but mishaps can also occur despite proper placement and positioning3-6. About 18% of IUCD users may experience expulsion and missing strings, however uterine erosion/ perforation is an uncommon, but serious, complication3 . Perforation may be asymptomatic or symptomatic. There could be varying symptoms like abdominal pain, chronic pelvic pain, abnormal vaginal or rectal bleeding, irritative lower urinary tract symptoms, bowel or bladder perforation, peritonitis, unwanted pregnancy, intestinal obstruction, abscess or fistula formation depending on the organ of penetration and the interval from the time of penetration and patient’s response3- 5 . Here, we report a case of an IUCD migrating through the uterus into the peritoneal cavity and uninterruptedly into the rectum.
Mrs. A.O a 31-year-old Para 2+0 (2 Alive) woman had an uncomplicated IUCD (Copper-T 380A) inserted and subsequently, could not feel the strings within 1 week of its insertion. There was no history of abdominal pain or abnormal vaginal or rectal bleeding. However, she did not present in the hospital despite the pre and post insertion counseling given to her. Three months after the IUCD insertion she missed her period. Ultrasound done confirmed a 9weeks live gestation and showed a displaced IUCD in the uterine wall. She was counseled on the complications of pregnancy with IUCD in-situ and it was planned for removal after delivery. Pregnancy was otherwise uneventful until late third trimester when she had premature labour and delivery of a live male neonate at 35 weeks gestational age. She did not present in the hospital after delivery as scheduled because of the fear of surgery until 3 months postpartum when she noticed the IUCD strings protruding from her anus (Fig. 1).