Extrauterine migration of an intrauterine device to the right iliac fossa: a rare case report

Abstract

Intrauterine devices (IUDs) are highly effective, reversible methods of contraception, but uterine perforation and extrauterine migration are uncommon complications. We report the case of a 32-year-old multiparous woman who presented by self-referral from another healthcare facility with a two-week history of right iliac fossa pain and a history of IUD insertion. Abdominal ultrasonography was unremarkable but demonstrated an empty uterine cavity despite the absence of a history of IUD expulsion. A plain abdominal radiograph was subsequently obtained, which demonstrated the IUD in the right iliac fossa. She underwent open exploratory laparotomy, which revealed the IUD lying freely in the right iliac fossa close to the fimbrial end of the right fallopian tube. There was no identifiable uterine perforation, scar, or defect. However, the right fallopian tube was oedematous, raising the possibility of an unusual route of migration through the right uterine ostium, along the fallopian tube and through the fimbrial end into the peritoneal cavity. The IUD was removed, and bilateral tubal ligation was performed at the patient's request because she had completed her desired family size and declined other contraceptive methods. Her postoperative recovery was uneventful, and subsequent follow-up was satisfactory. This case highlights the importance of careful history taking, appropriate evaluation of a missing IUD, and prompt management, particularly in low-resource settings where advanced imaging and minimally invasive surgery may not be readily available.