International Journal of Gynecology & Obstetrics 71 Ž2000.

241᎐243

Brief communication

Laparoscopic removal of translocated

retroperitoneal IUD

K.K. Roy, N. BanerjeeU , A. Sinha

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India

Received 15 February 2000; accepted 17 February 2000

Keywords: Intrauterine devices; Uterine perforation; Retroperitoneum

Intrauterine contraceptive device ŽIUD. is a nancy report, performed medical termination of

safe and effective method of contraception widely
used in various countries. A potentially serious
complication is perforation of the uterus, with a
reported incidence of 0.5᎐1r1000 insertions w1x.
After perforation, these devices have been found
in various locations in the pelvis and abdomen w2x.
We report a rare case of a Multiload translocated
into the retroperitoneum. It was found lying just
above the right ureter and pelvic vessels, and was
successfully removed laparoscopically.
A 42-year-old para 4 had an interval insertion
of IUD, 2 years following her previous childbirth.
The insertion of Multiload had been done on the
7th day of the period and had been uneventful
with mild pain being the only complaint for the
first 2 days. Following the insertion, she became
overdue by 15 days. She consulted a private prac-
titioner who, after obtaining a positive urine preg-
U
Corresponding author. Fax: q91-11-6862663.
E-mail address: amiyaneelam@hotmail.com ŽN. Banerjee..
the pregnancy. The threads of the IUD could not
be seen and it could not be removed during the
procedure, nor was it found in the products of
gestation. There was no history suggestive of ex-
pulsion of the device. She was referred to us as a
case of misplaced IUD. Local examination de-
monstrated a complete perineal tear which had
occurred during her last childbirth, and for which
she had not sought any treatment. Pelvic exami-
nation revealed a normal sized uterus. Per rectal
examination was also normal except for complete
perineal tear. On ultrasonography, the IUD was
not seen in the uterine cavity or buried in the
myometrium. Plain X-ray of the abdomen, an-
tero᎐posterior view, revealed the IUD near the
bony pelvis on the right side ŽFig. 1.. Lateral view
film showed it to be lying anterior to the sacrum.
As there was no suspicion of an intrauterine IUD,
laparoscopy was planned. On laparoscopy, the
uterus appeared normal and the perforation site
could not be seen. There were no adhesions in

0020-7292r00r$20.00 䊚 2000 International Federation of Gynecology and Obstetrics. All rights reserved.
PII: S 0 0 2 0 - 7 2 9 2 Ž 0 0 . 0 0 2 1 3 - 7
242 K.K. Roy et al. r International Journal of Gynecology and Obstetrics 71 (2000) 241᎐243

Fig. 1. Antero᎐posterior X-ray view showing an IUD lying on the right side of the pelvis.

the pelvis and the IUD could not be seen either systematically inspected. After an exhaustive
in the pelvis or in the abdominal cavity, which was search, a faint impression of a curved object was

Fig. 2. Schematic diagram showing an IUD lying retroperitoneally just over the right ureter and the iliac vessels ŽU s uterus,
O s ovary, USs uterosacral, UTs ureter, IV s iliac vessels; ‘X’ shows the location of IUD..
 K.K. Roy et al. r International Journal of Gynecology and Obstetrics 71 (2000) 241᎐243
seen on the right pelvic wall, lateral to the
uterosacral ligament in the ovarian fossa ŽFig. 2..
On gentle probing, the limb of the IUD could be
felt. The peritoneum overlying it was intact and
smooth and there was no evidence of any fibrosis
to suggest perforation at that site. The peri-
toneum was incised and the IUD removed by
gentle traction taking care not to injure the ureter
and the iliac vessels. Hemostasis was achieved by
careful cautery of the peritoneal edges. The ureter
was checked for peristalsis. Bilateral tubal liga-
tion was performed. Complete perineal tear was
repaired in the same sitting. The patient was
discharged on the fourth post-operative day, in
good health.
To the best of our knowledge, this was the first
case of a translocated IUD lying retroperitoneally
at this site. Misplaced IUDs have been found in
the ovarian fossa, but they have been found lying
free within the abdominal cavity, without any
retroperitoneal perforation w2x.
243
In our case, the close proximity of the IUD to
the ureter and pelvic vessels could have posed
grave danger. The integrity of these structures
could have been damaged either by, perforation
by the IUD, or during its removal. This case
demonstrates that laparoscopic removal of trans-
located IUD from this difficult site is safe and
effective. It also highlights the need to inspect the
abdominal walls and retroperitoneum carefully
when a translocated IUD is not found in the
pelvic or abdominal cavity.
References
w1x Gentile JP, Siegler AM. The misplaced or missing IUD.
Obstet Gynecol Surv 1977;32:627᎐641.
w2x Zakin D, Stern WZ, Rosenblatt R. Complete and partial
uterine perforation and embedding following insertion of
intrauterine devices. I. Classification, complications,
mechanism, incidence, and missing string. Obstet Gy-
necol Surv 1981;36:335᎐353.