RESUMO
This case shows that abdominal and pelvic x-ray examinations may not adequately show a misplaced IUD in a gravid woman, and further workup is necessary after delivery if the IUD is not clearly visible on the initial x-ray films. It also shows that chronic inflammation may develop in the area of a misplaced IUD, producing chronic abdominal pain and complications, even after several years have transpired. Finally, patients may still be at risk for complications after an IUD has been removed because of the dense adhesions that develop due to the chronic inflammatory response elicited by the IUD.
PIP: Appendicitis caused by a misplaced IUD was found in a 29-year-old pregnant woman. The woman had had the device inserted 8 years before. About 5 months after placement and a severe experience of right lower quadrant pain, medical examination revealed that she was pregnant. Abdominal and pelvic X-ray films were thought to be consistent with IUD expulsion, a fairly common occurrence, with an estimated rate of 2-20% within 1 year of placement. Over the next 7 years, the woman continued to experience right lower quadrant pain, but the pain was mild until 20 weeks into her next pregnancy when she was hospitalized with nausea, anorexia, fever, and severe pain. Surgery revealed that her appendix and cecum were bound to an inflamed mass of tissue. During the course of an appendectomy, this tissue mass was found to contain a copper-coated IUD, which was removed by blunt dissection and gentle traction. The IUD had probably partially perforated the uterus on insertion; complete perforation followed in 2-3 months; and copper from the device caused inflammation that eventually involved the appendix. Several months after the appendectomy, it was discovered that the inflammatory mass had been replaced by dense adhesions. This case shows that abdominal and pelvic X-ray examinations may not be sufficient to locate a misplaced IUD in a pregnant woman. If a misplaced device is not clearly visible on X-ray films, further workup may be necessary to avoid the possibility of chronic abdominal pain and complications.
