Colocolic fistula caused by a previously inserted intrauterine device. Case report.

ABSTRACT

PIP: The incidence of uterine perforation following IUD insertion has been estimated as 1.2/1000 insertions. Presented is the case of a 30-year-old woman from Scotland who became pregnant for the third time following insertion of a Multiload Copper 250 device 6 weeks after the delivery of her second child, while she was still breast feeding. The IUD was not removed antenatally because the locator strings could not be visualized. The pregnancy was uncomplicated, with no gastrointestinal symptoms. Failure to detect the IUD at the time of delivery necessitated laparoscopy and laparotomy to locate the IUD and colotomy to retrieve the device. The IUD was located on the left side of the pelvis in the region of the descending colon. One arm had eroded through the full thickness of the sigmoid colon and the other had penetrated the adjacent loop of the colon, forming a colocolic fistula. This case confirms the observation that the puerperium is the time of greatest risk of IUD-caused uterine perforation. Although perforation is most common at the time of insertion, this complication also can occur with a previously placed device. Failure to localize and remove the IUD can result in severe intra-abdominal complications.