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Intestinal Perforation by a Migrated Intrauterine Contraceptive Device: A Review of This Rare but Important Complication

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Abstract

Intrauterine contraceptive devices (IUCDs) are one of the most popular forms of modern contraception. We present a case of IUCD migration into the sigmoid colon and associated abscess formation, with a literature review to aid surgeons in recognising, investigating and treating this rare complication. This is the most comprehensive known review of this subject to date. PRISMA guidelines were used. All case reports published up until the 15th March 2020 were included, if they described migration of a modern T-shaped IUCD relating to or penetrating intestinal viscera. Fifty-two cases were suitable for inclusion. Abdominal pain (48.9%) and failure of contraceptive effect (42.6%) were non-specific but common presentations. Laparoscopic retrieval was frequently attempted, but with relatively low success rates. Adhesions, visceral involvement and abscesses were associated with failure, conversion to open surgery, bowel resection and stoma formation. Asymptomatic migration was likely to be underestimated and presents an argument for non-operative management, although not currently recommended by national and international guidelines. Although limited by reporting biases and the small number of cases available, our review highlights that diagnosis requires a high index of suspicion, regardless of menstrual status. It also demonstrates the importance of cross-sectional imaging prior to management, balanced with the risks of radiation exposure, to allow informed consent and avoid failed retrievals.

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Acknowledgements

We would like to thank the patient who inspired the creation of this review and agreed to the inclusion of their case as part of it.

We would also like to acknowledge the Whittington Health Library for conducting the database search.

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  1. Whittington Health NHS Trust, Magdala Avenue, London, UK

    Antony Zacharias, Stephanie Clark, Chetan Parmar & Ayo Oshowo

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  1. Antony Zacharias
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AZ and SC identified studies and extracted and analysed data. All authors (AZ, SC, CP, AO) contributed to the discussion, drafting and finalisation of the review.

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Correspondence to Antony Zacharias.

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Zacharias, A., Clark, S., Parmar, C. et al. Intestinal Perforation by a Migrated Intrauterine Contraceptive Device: A Review of This Rare but Important Complication . SN Compr. Clin. Med. 3, 1759–1767 (2021). https://doi.org/10.1007/s42399-021-00923-2

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