Journal of Womens Health, Issues and Care ISSN: 2325-9795

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Case Report, J Womens Health Issues Care Vol: 4 Issue: 1

Migrated Asymptomatic Intrauterine Contraceptive Device Presenting as Foreign Body Granuloma in Abdominal Cavity: Case Report with Review of Literature

Sreelakshmi Kodandapani1*, Ashwini H Pai1 and NG Lahoti2
1Department of OBG, Subbaiah Institute of Medical Sciences, Shimoga 577201, India
2Department of Surgery, Subbaiah Institute of Medical Sciences, Shimoga, India
Corresponding author : Sreelakshmi kodandapani
Department of OBG, Subbaiah Institute of Medical Sciences, Shimoga 577201, India
Tel: 9686299600
Email: [email protected]
Received: September 15, 2014 Accepted: January 02, 2015 Published: January 08, 2015
Citation: Kodandapani S, Pai AH, Lahoti NG (2015) Migrated Asymptomatic Intrauterine Contraceptive Device Presenting as Foreign Body Granuloma in Abdominal Cavity: Case Report with Review of Literature. J Womens Health, Issues Care 4:1. doi:10.4172/2325-9795.1000177

Abstract

Migrated Asymptomatic Intrauterine Contraceptive Device Presenting as Foreign Body Granuloma in Abdominal Cavity: Case Report with Review of Literature

Intrauterine contraceptive device is a well-accepted contraception worldwide. Perforation and migration is a serious complication amongst IUCD users. We present a 27 year old para 2 with previous normal delivery. She had IUCD after first child. She consulted doctor for missing device and was told to have a probable expulsion after workup. She came to us for laparoscopic sterilization. IUCD was found as foreign body granuloma in the abdomen at anterior abdominal wall which was laparoscopically retrieved.

Keywords: IUCD; Anterior abdominal wall; Laparoscopy

Keywords

IUCD; Anterior abdominal wall; Laparoscopy

Introduction

Intrauterine contraceptive device (IUCD) is considered safe and well-accepted contraception worldwide. IUCD is associated with many side effects. Perforation is a serious complication amongst IUCDS users with an incidence of 1 in 350- 1 in 2500 [1]. However migration of IUCD into peritoneal cavity is via uterus, fallopian tube. They may present with abdominal symptoms, peritonitis or may remain asymptomatic [2]. IUCD should be retrieved even if asymptomatic either by laparoscopy or laparotomy depending upon the case, facilities and expertise [3].

Case Report

A 27 year old para 2 presented to us for laparoscopic sterilization. She had previous two normal deliveries. She did not have any significant symptoms. At laparoscopy, uterus, fallopian tubes, ovaries and pouch of Douglas were normal and fallopian rings applied. We noticed cyst like structure with dense adhesions of about 5 cm just below anterior abdominal wall, near left iliac fossa. At dissection of cyst, IUCD popped out with pus. IUCD along with granulomatous tissue retrieved (Figure 1).
Figure 1: Anterior abdominal wall seen with tail of Copper T as soon as cyst of anterior abdominal wall was dissected.
Patient received injectable antibiotics for 3 days and postoperative period was uneventful (Figure 2) .
Figure 2: Multiload Cu T is clearly seen after complete dissection from anterior abdominal wall.
At subsequent history, patient had IUCD after first child. She had consulted doctor for removal after 3 years. After examination and ultrasound by Doctor, probable expulsion was considered. X ray abdomen was not done and patient was asymptomatic.

Discussion

Since introduction in 1965, intrauterine contraceptive device is cost effective contraception used for birth spacing. Various IUCDs are available, namely: Cu T 380A, Cu T 200, Multiload 375, etc. Side effects of IUCD depend upon design, copper content, method of placement and time of insertion. Side effects are pelvic pain, white discharge, menorrhagia and bleeding.
Migration of IUCD is one of the rare complications. Risk factors are postpartum insertion, postabortal insertion and nullipara. Gut peristalsis, bladder contractions and movement of peritoneal fluid are the probable contributory factors. Perforation of IUCD is rare and is due to penetration of uterine wall. This leads to dreaded complications like peritonitis or intestinal obstruction. Trans uterine migration of IUCD can go to colon, wall of iliac vein, bladder, appendix, omentum, perirectal fat, retroperitoneal space, pouch of Douglas and ovaries.
Many IUCD remain asymptomatic and are incidentally removed when opened for other indication. Imtiaz et al., [4] has reported a case of progressive abdominal wall swelling which was IUCD at laparotomy. Authors presumed as appendicular mass, but at laparotomy it was IUCD. Retrospectively, patient had history of missing IUCD.
Muhammed ansari et al., reported a case of acute abdomen with CuT embedded in the right iliac fossa upto anterior abdominal wall, which mimicked as acute appendicular lump [5]. Many cases of bladder perforation with vesical calculi are reported [6]. Perforation into rectum, sigmoid colon and as many as 15 cases of appendix complications are reported so far [7-9]. Mulayam B et al., [10] reported a case of IUCD in anterior abdominal wall presenting as tender swelling which probably perforated uterus at the time of D&C. Rashid shah et al., [11] reported a case of progressive swelling at anterior abdominal wall due to asymptomatic migration of IUCD and patient similar to our case had given birth a child previously. Above case is the only asymptomatic presentation similar to our case. Rest of the cases presented either as appendicular mass or vesical calculus. Table 1 summarises previous similar case reports.
Table 1: Low molecular weight PAI-1 antagonists.

Conclusion

IUCD remains the good choice of contraception, especially as a birth spacing method. However patients should be educated about regular follow up after IUCD insertion. Adequate examination and investigations like ultrasound, X- ray abdomen and pelvis are needed for missing IUCD.

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