Migrated intrauterine contraceptive device in the anterior abdominal muscle Ogunlaja OA, Akinola SE, Aworinde OO, Ogunlaja IP, Awotunde OT

CASE REPORT

Year : 2018 | Volume : 7 | Issue : 1 | Page : 71-73

Migrated intrauterine contraceptive device in the anterior abdominal muscle

Olumuyiwa A Ogunlaja¹, Samuel E Akinola¹, Olufemi O Aworinde¹, Idowu P Ogunlaja², Olufemi T Awotunde³
¹ Department of Obstetrics and Gynaecology, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
² Department of Obstetrics and Gynaecology, General Hospital, Ilorin, Kwara State, Nigeria
³ Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria

Date of Web Publication

16-Apr-2018

Correspondence Address:
Olumuyiwa A Ogunlaja
Department of Obstetrics and Gynaecology, Bowen University Teaching Hospital, Ogbomoso, Oyo State
Nigeria

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sjhs.sjhs_85_17

Abstract

Intrauterine contraceptive device (IUCD) is a common means of contraception in females which has a risk of getting missing due to its migration by means of perforating the uterus. Mrs. MB is a 36-year-old Para 4 + 0 4 alive woman who presented in our clinic with a history of vague tenderness in the left lower abdomen of 4-week duration. She was examined and her IUCD tag was missing, investigations result was further suggestive of a displaced IUCD. She subsequently had a mini-laparotomy following which the IUCD was retrieved from the anterior abdominal wall. Her postoperative recovery was satisfactory. Health workers need to be trained and re-trained on the contraceptive methods, especially IUCD. The areas of emphasis should be on criteria for proper selection of client, insertion techniques to reduce primary perforation of the uterus, and protocols on proper follow-up to reduce complication of secondary perforation of the uterus.

Keywords: Anterior abdominal muscle, intrauterine contraceptive device, migrated

How to cite this article:
Ogunlaja OA, Akinola SE, Aworinde OO, Ogunlaja IP, Awotunde OT. Migrated intrauterine contraceptive device in the anterior abdominal muscle. Saudi J Health Sci 2018;7:71-3

How to cite this URL:
Ogunlaja OA, Akinola SE, Aworinde OO, Ogunlaja IP, Awotunde OT. Migrated intrauterine contraceptive device in the anterior abdominal muscle. Saudi J Health Sci [serial online] 2018 [cited 2022 Jun 27];7:71-3. Available from: https://www.saudijhealthsci.org/text.asp?2018/7/1/71/230233

Introduction

Modern contraceptives are available in different forms, i.e., oral contraceptive pills, foaming tablets, creams, jelly, injectables, implants, intrauterine devices, and barrier methods (in the form of condoms for males and females), as well as permanent surgical methods. The focus of most family planning programs is on promoting adoption of modern contraceptive methods. The availability and use of appropriate contraceptive methods for family planning are important in controlling population growth and other complications of pregnancy.^[1]

Intrauterine contraceptive device (IUCD) is a common means of contraception, it is preferred by many women seeking contraception, but it has complications such as excessive bleeding, pain, infection, uterine perforation, and spontaneous expulsion.^[2],[3] A rare but dreadful complication of IUCD is uterine perforation; it occurs in 0.5/1000 insertions.^[4] This complication should be avoided because its manifestations are occasionally silent and it could contribute to contraceptive failure or even aid the migration of the IUCD to the peritoneum, bladder, bowel or even the anterior abdominal wall muscles as presented in the case below.^[5]

There is an important need to train and retrain health-care workers on the proper techniques of the insertion of IUCD to limit the complications associated with the use of this contraceptive agent thus promoting its efficacy.

Case Report

Mrs. MB is a 36-year-old Para 4 + 0 4 alive woman who presented in our clinic with a history of vague tenderness in the left lower abdomen of 4 weeks' duration. The pain was dull and non-radiating, neither known aggravating nor relieving factors, no prior history of trauma to the abdomen. There is no associated urinary, no history of fever, and no abnormal vaginal discharge. Her last menstrual period was 1 week before presentation. Since onset of symptoms, she had not sought for care in any health-care facility and did not use any traditional care. She had IUCD inserted about 3 years earlier in a primary health center and had no complaint following its insertion.

Her general clinical condition was satisfactory; she had a vague tenderness in the left iliac region. Pelvic examination revealed an absence of IUCD tag. Hence, a provisional diagnosis of a missing IUCD was made. She subsequently had a plain abdominal X-ray which revealed a displaced IUCD in the left iliac region [Figure 1]. Ultrasound report was suggestive of a foreign body? IUCD in the anterior abdominal wall. Other investigation result like the packed cell volume, fasting blood glucose and serum electrolyte urea and creatinine were essentially normal.

Figure 1: Plain abdominal X-ray showing migrated intrauterine contraceptive device in the left iliac region

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She subsequently had a minilaparotomy, findings includes an IUCD embedded in the anterior abdominal wall muscle with the omentum at the site of penetration of the anterior abdominal wall muscle [Figure 2] and [Figure 3], grossly normal uterus, Fallopian tube ^{More Details}s, and ovaries. Her postoperative recovery was satisfactory.

Figure 2: Intrauterine contraceptive device embedded in the anterior abdominal wall muscle

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Figure 3: Retrieved intrauterine contraceptive device from the anterior abdominal wall muscle

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Discussion

Migrated IUCD may not be discovered until it is found missing or patient becomes pregnant. Sometimes they may present with abdominal or urinary disturbances. Postinsertion women should have follow-up visits. A client on IUCD for family planning should be instructed to contact health facility if the IUCD threads cannot be felt, she or her partner can feel the lower end of IUCD especially during coitus, when there is persistent abdominal pain, fever, dyspareunia, unusual vaginal discharge and when she misses periods. In the case presented above, she was experiencing lower abdominal pain which was worse on the left, and this was the area of location of the missing IUCD.

Literature search reveals that migration of IUCD could be primary uterine perforation which is said to occur at time of insertion or secondary uterine perforation which occurs due to due to slow migration of Copper T through the uterus with the concurrent bowel peristalsis, spontaneous uterine contractions, and bladder contractions.^[6],[7] The latter can be due to errors like faulty technique which may be due to poor lightening, wrong choice of instruments, and lack of client cooperation during insertion. Others are inappropriate timing of insertion, soft uterine wall, abnormal uterine anatomy, and wrong measurement of uterocervical length. However, the former, i.e., secondary uterine perforation usually occurs silently and not much can be done to detect it early rather than routine radiologic investigation once the IUCD tag is not felt by the patient.

Other areas of migration of IUCD includes colon, wall of iliac vein, bladder, appendix, omentum, perirectal fat, retroperitoneal space, pouch of Douglas, ovaries, and rarely lower anterior abdominal wall as presented in this case report.^[8],[9],[10]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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