Combined laparoscopic-colonoscopic approach for the removal of a migrated intrauterine contraceptive device penetrating the sigmoid colon

Abstract

Uterine perforation is a rare but potentially lifethreatening complication associated with the use of intrauterine contraceptive devices (IUDs). Following perforation, the IUD can migrate to the peritoneal cavity or even perforate several adjacent organs. Migration to the sigmoid colon is extremely rare. We present the case of a 28-year-old woman who had an IUD inserted soon after delivery. The patient again became pregnant, but no IUD could be detected in routine examinations. After an asymptomatic interval of 3 years, the patient suffered acute abdominal pain. Initial laparoscopy elsewhere revealed the IUD attached to the sigmoid colon, but extraction was not possible. The patient was referred to us for further treatment. Under general anesthesia, laparoscopic exploration of the abdomen was performed. The IUD had perforated the sigmoid colon and was firmly fixed. In order not to injure the sigmoid colon, laparoscopic mobilization of the IUD was assisted with a "rendez-vous" sigmoidoscopy. The IUD was removed transanally with laparoscopic and sigmoidoscopic assistance, and the patient was discharged within 24 h after the operation. Insertion of an IUD necessitates regular checks to confirm the device's correct position. Migration of an IUD warrants prompt laparoscopic removal, even in asymptomatic patients.

Peritoneal Carcinomatosis with Displaced IUCD

“…Uterine perforation may occur during insertion or later. Most of the perforation is by copper containing devices [8] and they generally produce symptoms from inflammatory reaction to copper [9]. Non-copper containing inert IUCDs such as Lippes loop causes little symptoms, hence are detected only incidentally [9].…”

Mystery of the missing loop

“…[1][2][3][4][5][6][7] Most of the IUCD migrations have been of copper T which incites copious tissue reaction and is, hence, symptomatic. [1][2][3][4][5][6][7] Perforation of hollow viscous, intractable lower abdominal pain, persistent pelvic inflammatory disease, recurrent urinary infections, vesical stone formation and intestinal obstruction are some of the presentations. [1][2][3][4][5][6][7] However, IUCDs, such as, Lippes loop, are quite inert and cause little symptoms, hence, are detected incidentally, as evident by this case.…”

“…[1][2][3][4][5][6][7] Perforation of hollow viscous, intractable lower abdominal pain, persistent pelvic inflammatory disease, recurrent urinary infections, vesical stone formation and intestinal obstruction are some of the presentations. [1][2][3][4][5][6][7] However, IUCDs, such as, Lippes loop, are quite inert and cause little symptoms, hence, are detected incidentally, as evident by this case. 8 Disappearance of thread without history of spontaneous expulsion might trigger off search for missing device.…”

“…[1][2][3][4][5][6][7][8] Hysteroscopy, cystoscopy, endoscopy, plain radiographs, ultrasonography and CT have been used singly or in combination to locate the displaced IUCDs. [1][2][3][4][5][6][7][8] Management options for symptomatic migrations range from formal open surgery to minimally invasive techniques, depending upon the presentation/situation. 1,3,5,7 Opinion is divided regarding retrieval of those migrated IUCDs that do not cause any symptoms.…”

“…[1][2][3][4][5][6][7][8] Management options for symptomatic migrations range from formal open surgery to minimally invasive techniques, depending upon the presentation/situation. 1,3,5,7 Opinion is divided regarding retrieval of those migrated IUCDs that do not cause any symptoms.…”