The online version of this article (doi:10.1186/1752-1947-8-81) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
AW gathered data and prepared the initial manuscript. AW performed the surgery and PW made critical revisions to the manuscript. All authors were involved in the surgical care of the patient. NN supervised the project overall. All authors read and approved the manuscript.
The intrauterine device is a form of contraception with a long duration of action and few systemic side effects. Migration into the abdominal cavity may occur early or years after insertion giving rise to bowel obstruction, perforation, ischemia, mesenteric injury, strictures or fistulae. Colocolic fistula formation is a rare but serious complication of intrauterine device migration, which may lead to difficulties in diagnosis and device retrieval.
We report the case of a 29-year-old Sri Lankan woman who became pregnant 5 years after intrauterine device insertion. The device could not be located during pregnancy. She was asymptomatic and defaulted follow up during the antenatal period. She had an uncomplicated vaginal delivery. A subsequent laparotomy for device retrieval failed due to technical difficulties. A repeat laparotomy identified a sigmoid colocolic fistula with adhesions to the fallopian tube. The device was removed and colonic defects primarily closed following which the patient made an uneventful recovery.
All translocated intrauterine devices should be removed regardless of type and location. This case illustrates that they may cause complex bowel lesions leading to serious technical difficulties during retrieval. With the increasing use of minimally invasive approaches for intrauterine device retrieval, a low threshold for open surgery in complicated cases is advocated.
Prabhu JK, Rani R, Nayak NK, Natarajan P: Migration of intrauterine contraceptive device into sigmoid colon. J ObstetGynaecol. 2010, 30: 526-527.
Tosun M, Celik H, Yavuz E, Cetinkaya MB: Intravesical migration of an intrauterine device detected in a pregnant woman. Can Urol Assoc. 2010, 4: E141-E143.
Berger-Kulemann V, Einspieler H, Hachemian N, Prayer D, Trattnig S, Weber M, Ba-Ssalamah A: Magnetic field interactions of copper-containing intrauterine devices in 3.0-Tesla magnetic resonance imaging: in vivo study. Korean J Radiol. 2013, 14: 416-422. 10.3348/kjr.2013.14.3.416. CrossRefPubMedPubMedCentral
World Health Organization (WHO): Mechanism of Action, Safety and Efficacy of Intrauterine Devices (WHO Technical Report Series No. 753). 1987, Geneva, Switzerland: WHO, 48-63.
Kirkpatrick D, Schneider J, Peterson EP: Large bowel perforation by intrauterine contraceptive devices. Obstet Gynecol. 1975, 46: 610-612. PubMed
Chi E, Rosenfeld D, Sokol TP: Laparoscopic removal of an intrauterine device perforating the sigmoid colon: a case report and review of the literature. Am Surg. 2005, 71: 1055-1057. PubMed
- Sigmoid colocolic fistula caused by intrauterine device migration: a case report
- BioMed Central