Displaced Intrauterine Device with Rectal Perforation: A Practical and Novel Approach of Removal
IUGA Academy. Cadiz M. Jun 30, 2018; 212952
Dr. Mary Rani Cadiz
Dr. Mary Rani Cadiz

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Displaced intrauterine device with rectal perforation: A practical and novel approach of removal

Cadiz, MR1; Joanne Karen, A1; Jabson, LT1; Amin-Ong, A1

1: Philippine General Hospital

Introduction: Copper intrauterine device (IUD), a long-acting, reversible contraception, has a low failure rate and a ten-year lifespan. Though safe, it comes with a handful of possible complications. Expulsion, displacement, and perforation are rare adverse events that have been reported.1 One hypothesis is the presence of chronic inflammatory reaction to the copper-containing IUD which leads to gradual uterine wall erosion.2 Although there is no guideline, the recognized management for IUD-associated perforations has been abdominal surgery through laparotomy or laparoscopy.

Objective: This case presents a rectally embedded IUD removed by transvaginal and transrectal route.

Methodology: Case Report

Result: A 27-year-old postpartum presented with rectal pain and palpable string coming out of her anus, 5 months post-IUD insertion. An assessment of displaced IUD was made in a local hospital where she was offered exploratory laparotomy with total hysterectomy. A tertiary hospital referral was also done for second opinion. On pelvic examination, the firm non-movable end of a probable arm of the IUD was palpated beneath the upper third of the posterior vaginal wall. On rectovaginal exam, the IUD string was felt within the rectal lumen but its origin nor the IUD arm cannot be discerned. Transvaginal ultrasound and pelvic CT scan showed displaced IUD with perforation of the posterior vagina and anterior rectal wall, 10-13cm from the anus. A multidisciplinary team discussed the least invasive surgical option for the patient. Circumventing the transabdominal route was preferred to avoid possible passage of the soiled IUD. Based on thorough pelvic examination and imaging studies, a combined transvaginal and transrectal removal of IUD was planned. This technique confers ease of repairing the rectum and vagina with ample visual and surgical access. The IUD was removed by culdotomy, transvaginal extraction of the IUD short arm, transanal extraction of the long arm with transvaginal layered repair of the rectal defect and repair of the culdotomy. A culdotomy was made and the short arm of the IUD was seen at the upper third of the anterior rectal wall serosa (Figure). The lowest edge of the IUD long arm was embedded at the anterior rectal wall, with the tip palpable on digital rectal examination, 6 cm from the anal verge. The short arm of the IUD was then cut, separating it from the long arm which was extracted from the rectal mucosa. Transvaginal layered repair of the anterior rectal wall defect was done while the vaginal epithelium was repaired with simple interrupted stitches. The patient was discharged without complications. She was able to follow up postoperatively with no subjective complaints. At present, the patient is asymptomatic and is on oral contraceptives.

Conclusion: A minimally invasive method of removing a displaced IUD is documented in this case. Through the transvaginal and transrectal approach of IUD removal, morbidity was minimized, postoperative pain was very tolerable, expenses were decreased, and the recovery period was faster while decreasing the risk of intraperitoneal infection.

1 International Journal of Women’s Health. 2010; 2:211-220

2 South Asian Federation of Obstetrics and Gynecology, May-August 2010;2(2):137-139. 137


Work supported by industry: no.

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