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A 51-year-old woman was referred to my clinic to exchange her Mirena® intrauterine system (IUS). The IUS was inserted 8 years ago under local anaesthetic at the local hospital, as the general practitioner was unable to insert the IUS due to a tight cervix, as the woman's three births had all been by Caesarean section.
The patient was counselled and the IUS was removed and shown to her, however the transverse arms were missing (Figure 1). The arms were not seen in the cylinder on exploration.
A pelvic ultrasound scan revealed the presence of the IUS arms in the upper part of the uterus, and the patient was referred to a gynaecologist who performed a hysteroscopy but was unable to locate the IUS arms. The patient was rescanned, which once again showed the presence of the IUS arms in the upper part of the uterus (Figure 2).
The radiologist's comment was that the arms were not in the endometrial cavity, and there was what the radiologist called a linear echogenicity at the top end of the uterus under the surface lining of the uterus, which were the IUS arms. An abdominal X-ray was proposed; however, the patient chose not to pursue the matter any further.
This type of problem has not been reported previously, and it may be observed more frequently, as an increasing number of IUS insertions are done in nulliparous women.
Competing interests None.
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