RESUMO
A 26-year-old woman consulted our Family Planning Unit because she could not locate the thread of her intrauterine device (IUD), which was placed 16 months earlier. Attempts to remove the IUD under fluoroscopy failed. A hysterography showed the IUD to be in the pelvis away from the uterus. At laparotomy, the IUD was found hidden in the omentum and its removal was done by resection of a piece of the omentum. The patient became pregnant three months later and gave birth to a healthy baby at term.
PIP: This article presents a case report involving a misplaced IUD in a 26-year old woman, para 2. The woman consulted a physician because she could not locate the thread of her IUD, a T-Cu-200 device, which had been inserted 16 months earlier. 3 attempts to remove the IUD under fluoroscopy failed. Hysterography revealed the IUD to be in the pelvis, away from the uterus. At laparotomy, the IUD was located hidden in the omentum and was removed by dissecting a piece of the omentum. Inspection of the uterus failed to reveal a macroscopic defect that could suggest the perforation through which the IUD passed into the pelvis. In addition, histologic examination of the omentum resected showed no reaction to any foreign body. The patient became pregnant 3 month later and gave birth to a healthy infant at term. 3 possible explanations are proposed for the IUD misplacement noted in this case: 1) the uterine perforation during insertion was incomplete, and completed several months later; 2) the perforation happened progressively by imbedding of the IUD in the uterine wall; and 3) the perforation occurred during the first 2 unsuccessful removal attempts (which seems improbable given the lack of recent scar tissue on the uterus). It is recommended that, in cases of misplaced IUDs, the device should be removed by laparoscopy or laparotomy.
