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Delayed presentation of uterine and bowel perforation following insertion of an intrauterine device
  1. John Joseph Reynolds-Wright1,
  2. Rebecca L Heller2
  1. 1MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
  2. 2Chalmers Centre for Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
  1. Correspondence to Dr John Joseph Reynolds-Wright, Chalmers Centre, Edinburgh EH3 9ES, UK; john.reynolds-wright{at}nhs.net

Abstract

Introduction Insertion of intrauterine methods of contraception (IUC) carries an inherent but small risk of perforation of the uterus, usually quoted at 2 in 1000. If perforation occurs, it is usually discovered either when a patient presents with ‘missing threads’ or with an unplanned pregnancy. Rarely, if the IUC has perforated bowel, patients can present acutely unwell although this sometimes occurs years after insertion. Asymptomatic perforation of the bowel (with IUC insertion or otherwise) is not common.

Case history In January 2018, a 41-year-old woman attended our community sexual and reproductive health service requesting removal of her intrauterine system (IUS). The clinic nurse performed this and during the consultation the patient revealed that several days earlier she had passed a previous ‘lost’ intrauterine device (IUD) when she opened her bowels. She came to believe this was an IUD inserted in 2006 that had been ‘lost’ and resulted in a pregnancy with her third child. We counselled her about her options and she had the IUS removed as she was worried this could happen again and opted to use condoms.

Conclusion This case reports an unusual presentation of a delayed and importantly ‘silent’ perforation of the uterus and bowel on insertion of IUC. The case highlights the importance of cross-specialty communication when an IUD has perforated or expelled resulting in a continuing pregnancy, so that appropriate imaging can be arranged following delivery of the baby.

  • education and training
  • family planning service provision
  • intrauterine devices
  • intrauterine systems
  • long-acting reversible contraception
  • case report

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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