Rare case of rectal perforation by an intrauterine device: Case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Intrauterine devices (IUDs) are safe, highly effective and reversible forms of contraception. Reliance on IUD has been increasing and as such, it is the responsibility of the healthcare provider to be aware of the complications associated with it. IUD rectal migration is one of the rare but serious complications that may lead to detrimental sequelae. CASE PRESENTATION: A 30-year-old asymptomatic woman presented to the gynaecology clinic two months after a difficult insertion of an IUD. On examination, the device was not localised in utero with transvaginal sonography. Computed tomography scan and colonoscopy revealed the position of the IUD within the rectum. It was successfully retrieved with a combined laparoscopic-colonoscopic approach. Follow-up flexible sigmoidoscopy showed a well-healed rectal wall. CLINICAL DISCUSSION: IUD perforation can increase the risk of morbidity and necessitates early surgical intervention even if the patient is asymptomatic. Combined laparoscopic-colonoscopic approach allows for safe retrieval of IUD that has perforated the intraperitoneal rectal segment or is firmly embedded within the mucosa. Recognising the risk factors and adhering to the principles of IUD insertion could significantly lower the risk of perforation. CONCLUSION: This case report highlights the importance of a physician's vigilance regarding a perforating IUD in a patient with a history of a difficult insertion. It is imperative to undertake additional steps to rule out such a complication in these cases. Uterine perforation can be avoided with implementation of safe IUD insertion practice.

The aetiology and pattern of recurrent pregnancy loss.

The aims of this study were to determine the aetiological factors and the pattern of recurrent pregnancy loss in Kuwait. Ninety consecutive patients attending the special recurrent miscarriage clinic were studied prospectively. A comprehensive history of all previous miscarriages and pregnancies, past medical and gynaecological events were established. A physical examination was performed. Extensive investigations were performed. Pregnancies which occurred during the study were monitored carefully. The mean age of the patients was 30.46+/-6.04 years. The patients were subdivided into the groups of secondary (57%) and primary (43%) recurrent miscarriages. Eighty-five per cent of all previous miscarriages occurred in the first trimester. The main aetiological factors were uterine anomaly 2.2%, chromosome anomaly (parental) 2.2%, PCOS, infections and other miscellaneous factors 21.1%, positive antiphospholipid antibodies 33.3% and unexplained in 35.6%. The overall live birth rate was 82% and maternal morbidity was low. Positive antiphospholipid antibodies are the most frequently associated cause of recurrent pregnancy loss in Kuwait.