A case of a Missing Intrauterine Contraceptive Device

A report describes a case of a 41-year-old female, G6P6, who presented with a complaint of recurrent lower urinary tract symptoms (urinary frequency, urgency, and gross hematuria) for about seven months. She had a history of copper IUCD placement for years. However, it still caused an unexpected pregnancy, for which doctors thought that the IUCD had spontaneously expulsed, and she received a new IUCD after her last delivery ten years ago. She had no complaints since then; however, seven months ago, the patient experienced persistent urinary tract symptoms with a positive urine culture. 

A kidney, ureter, and bladder X-ray showed an intrauterine device and linear radiopaque foreign material just above and medial to the IUCD. Subsequent ultrasound revealed a hyperechoic shadowing material at the wall of the urinary bladder dome. The IUCD was removed, and further evaluation by computed tomography (CT) scan revealed a T-shaped foreign body (IUCD) impeded within the upper part of the posterior wall of the urinary bladder, or dome. The IUCD penetrated the bladder wall and caused local surrounding inflammation, which prompted the diagnosis of intravesical IUCD migration. The patient was planned for cystoscopic removal of the migrated IUCD. Cystoscopy revealed the IUCD stem penetrating the posterior wall of the urinary bladder with multiple small calculi or calcifications adherent to the intravesical portion. Cystoscopic removal of the migrated IUCD failed. Hence, a laparoscopy was carried out, which revealed multiple adhesions extending from the anterior abdominal wall to the urinary bladder dome or posterior wall. Adhenolysis was done by ligation. The IUCD arms protruded from the posterior urinary bladder wall between the serosal surface and the adhesions, with the body of the IUCD noted embedded within the bladder wall. The anterior bladder wall was dissected After inflating the urinary bladder, and a cystoscope was inserted for more exploration. The IUCD was removed, and the defect was then closed by a peritoneal flap. A methylene test ensured no leakage, and the operation was uneventful. At two weeks follow-up, retrograde cystography revealed no contrast leakage or fistula formation, and Foley's catheter was removed.

Natsheh ST, Manasra MR, Hammouri AG, et al. Retrieval of a Missing Translocated Intrauterine Contraceptive Device Using Combined Laparoscopic and Cystoscopic Techniques. Case Rep Obstet Gynecol. 2024 Apr 15;2024:2017479. Doi: 10.1155/2024/2017479.