Uterine perforation and migration of an intrauterine contraceptive device in a 24-year-old patient seeking care for abdominal pain

Abstract

Objective: The purpose of this case report is to describe the case of a 24-year-old woman complaining of diffuse abdominal pain following insertion of an intrauterine contraceptive device (IUC). Methods: A 24-year-old woman, 8 weeks postpartum, sought chiropractic care for intermittent stabbing pain in her left upper quadrant that had been present for a week. She returned 1 week later with no resolution of her complaint. She then recalled that, at her 6-week gynecological examination, she had undergone insertion of an IUC and that the abdominal pain had begun a week later. She was advised to return to her gynecologist. Subsequent evaluation by the gynecologist revealed that the IUC had perforated her uterus and had migrated to the upper left quadrant of her abdomen, where it was found anterior to the L1-2 vertebral bodies, lying in contact with the anterior surface of the abdominal aorta. To our knowledge, this is the only report of this type of presentation in a chiropractic office. Results: The initial intervention with this patient included chiropractic adjustment and myofascial release. At her subsequent visit, with no resolution of her complaint, she was referred back to her gynecologist for additional evaluation. Because the IUC had perforated her uterus, she underwent emergency laparoscopic surgery. The surgery was successful, and she recovered fully. Conclusion: Chiropractic physicians should consider uterine perforation by IUC in the differential diagnosis of a female patient of childbearing age seeking care for abdominal pain.

Migration of an intrauterine device causing severe hydronephrosis progressing to renal failure

“…Extremely retroverted uterus or uterine retroflexion has a higher incidence of IUD migration. [5] IUD inserted in early postpartum period (within 12 weeks after delivery) and failure of IUD are well-recognized risk factors of perforation. [6] The subinvolution of uterus and thinning of the uterine wall due to postnatal decline in estrogen levels could increase the risk of perforation.…”