Sigmoid colocolic fistula caused by intrauterine device migration: a case report

Abstract

IntroductionThe intrauterine device is a form of contraception with a long duration of action and few systemic side effects. Migration into the abdominal cavity may occur early or years after insertion giving rise to bowel obstruction, perforation, ischemia, mesenteric injury, strictures or fistulae. Colocolic fistula formation is a rare but serious complication of intrauterine device migration, which may lead to difficulties in diagnosis and device retrieval.Case presentationWe report the case of a 29-year-old Sri Lankan woman who became pregnant 5 years after intrauterine device insertion. The device could not be located during pregnancy. She was asymptomatic and defaulted follow up during the antenatal period. She had an uncomplicated vaginal delivery. A subsequent laparotomy for device retrieval failed due to technical difficulties. A repeat laparotomy identified a sigmoid colocolic fistula with adhesions to the fallopian tube. The device was removed and colonic defects primarily closed following which the patient made an uneventful recovery.ConclusionsAll translocated intrauterine devices should be removed regardless of type and location. This case illustrates that they may cause complex bowel lesions leading to serious technical difficulties during retrieval. With the increasing use of minimally invasive approaches for intrauterine device retrieval, a low threshold for open surgery in complicated cases is advocated.

Perforation of the appendix and the sigmoid colon by an ectopic IUD

“…5 Early presentations are most often symptomatic and most frequently include complaints of abdominal and pelvic pain, while late presentations are usually assymptomatic with complaints of missing IUD strings on selfexamination or pregnancy. 1,6,7 According to Balci et al the diagnosis of ectopic Intrauterine device can often made with ultrasonography as first line and pelvic radiography should be recommended when ultrasonography fails to locate the missing device. 7 Taras and Kaufman recommended either…”

“…Delayed removal may lead to a more technical surgical intervention and possibly increased morbidity from multiple surgical procedures and complications. 6 Symptomatic patients may present with abdominal pain or features suggestive of abdominal sepsis. There have been reports of sigmoid colon or small bowel perforation with peritonitis, 4 colo-colonic fistula 6,7 peri-colonic or tubo-ovarian abscesses with complaints of fever, abdominal pain and diarrhoea depending on site of the collection.…”

“…1,11 Difficult laparoscopic cases often result in intra-abdominal spillage of bowel contents and intra-abdominal sepsis and increased patient morbidity. 6,11 Careful consideration for laparotomy versus laparoscopic retrieval should be individualized based on an accurate pre-operative identification of the location of the device. 6,8 Laparoscopic removal might not be an option in cases with dense adherence of bowel and urogenital organs to the missing IUD, such cases might benefit from a laparotomy from the outset.…”

“…6,11 Careful consideration for laparotomy versus laparoscopic retrieval should be individualized based on an accurate pre-operative identification of the location of the device. 6,8 Laparoscopic removal might not be an option in cases with dense adherence of bowel and urogenital organs to the missing IUD, such cases might benefit from a laparotomy from the outset. 11 The most common post-operative complication following laparotomy and bowel resection for translocated intrauterine device include adhesive small bowel obstruction as seen in our case.…”

Sigmoid Colon Migration of an Intrauterine Device

“…However it also has some serious complications such as perforation of the uterus and its migration to the abdominopelvic structures  [3]. The primary perforation may occur during insertion by mechanical forces.…”