Lauren Schiff, MD
Women’s Health Services, Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
Uterine perforation at the time of intrauterine device (IUD) insertion is estimated to occur at a rate of 1 per 1000 insertions. Most published cases describing transmigration into abdominal viscera are in the setting of uterine perforation. In the case described here, IUD transmigration into the bowel lumen is chronologically documented in early pregnancy and apparently unrelated to uterine perforation.
A 36-year-old gravida 7, para 7 woman seeking permanent sterilization explained that she became pregnant with her last child with a copper IUD in place. The device was intrauterine on her first obstetric ultrasonogram at 6 weeks, 2 days of gestation. Subsequent ultrasonography 2 days later revealed no intrauterine IUD. The patient had a successful full-term delivery. Four months following delivery, the IUD was found on an abdominal X-ray at the level of the sacrum. On laparoscopic evaluation, the IUD was found embedded in the lumen of the sigmoid colon with only the strings visibly protruding through the serosa.
The rates of bowel injury related to IUD insertion and delayed translocation are unknown. The mechanism of translocation is not fully understood. A possible mechanism may be partial- to full-thickness myometrial penetration at the time of insertion allowing fistualization between the uterus and a hollow viscus via inflammatory processes. The documented early pregnancy translocation of an IUD suggests that intrauterine pregnancy may be the impetus for this process and reinforces the recommendation to remove an intrauterine IUD in pregnancy at the time of diagnosis.