We report an asymptomatic 23-year-old female patient who was diagnosed to have a transmigrated intrauterine device (IUD) during a routine gynecological examination. After the IUD had been located within the colonic wall by further investigation, the IUD was successfully extracted via transanal route by colonoscopic intervention.
The intrauterine device (IUD) is a safe and economic method of long-term reversible contraception and is the most commonly used contraceptive method in Turkey if the behavioral methods are excluded.
Transmigration of IUD to colonic wall is an extremely rare complication of IUDs. The incidence of uterine perforation related to the placement of IUD is estimated as 1.2-1.6 per 1000; however, the incidence of transmigration of IUD to colonic wall is not known because of limited number of cases reported so far.
We present an asymptomatic female patient who was incidentally diagnosed to have a transmigrated IUD during a routine gynecological examination. After further investigations had revealed transmigration of IUD to colonic wall, colonoscopic removal of IUD was successfully carried out.
Case Report
A 23-year-old gravida 2, para 2 asymptomatic woman admitted to a gynecologist for a routine examination. She had IUD application for birth control approximately 1 year ago, when she was in the sixth postpartum month of her last delivery. Thereafter, she admitted to the gynecologist for foul-smelling vaginal discharge 1 month after the application of IUD. The gynecologist carried out a pelvic examination and string check but no ultrasound and prescribed a medical therapy for vaginitis. In the present examination, however, the IUD was not found in normal intrauterine position by either pelvic examination or transvaginal sonographic scan. When further questioned, she reported intermittent abdominal pain and diarrhea.
Abdominal examination was unremarkable. Vaginal flatus and leakage of stool or urine from her vagina was not present. Complete blood count was within normal limits. A urine test was normal. Fecal occult blood test was positive. Combined anteroposterior and lateral abdominal X-rays showed the IUD located in the left side of the pelvis. After free perforation and peritonitis had been excluded, a flexible rectosigmoidoscopy was performed to locate the IUD. A fistula orifice between the mucosal foldings of the colonic wall at the 18th cm distal to anal verge and the leg of the IUD within the orifice was found ( Figure 1 ).
Mechanical bowel preparation with oral saline laxative and sodium phosphate enema and a single dose of prophylactic antibiotherapy with ampicillin-sulbactam were administered prior to interventional endoscopy. After the fistula orifice had been reidentified, it was extended to 0.8 mm with a needle-knife sphincterotome ( Figure 2 ), and the leg of the IUD was completely exposed ( Figure 3 ). Snare and dormia baskets were used to apply retraction of the IUD, and eventually the IUD was removed via transanal route ( Figure 4 ). The procedure was terminated without further manipulation ( Figure 5 ).
