02 9 / 2013

A 34yo woman was admitted to the outpatient urology clinic for acute right lumber pain, her medical history revealed medical treatment for right lower back pain with no previous abdominal or urologic surgery, five years before, three years after her second delivery, she had undergone an IUD placement, there had been no further examinations from that time for the IUD’s location and the IUS had not been replaced or removed, she even got pregnant two years after the IUD insertion and had an abortion, she had no severe chronic or acute pelvic and/or abdominal pain during the past years; her physical examination was normal, routine laboratory investigations, including urinalysis, revealed normal findings; a plain x-ray of the abdomen demonstrated an opaque spiral shaped shadow, resembling an IUD, located in the right upper quadrant of the abdomen; computerized tomography of the pelvis and abdomen confirmed the IUD at the right half of the abdomen in the mesentery, to remove the intra abdominally far migrated IUD, we planned a laparoscopic removal of the apparatus, however, the patient didn’t want surgery since she had no severe symptoms over the past years following the IUD placement, this patient presented with a very rare far migrated intra abdominal IUD, clinicians should be mindful of asymptomatic patients with previously placed IUDs; periodic follow-up is mandatory, laparoscopic removal of the intra abdominal IUD or conservative management could be preferred based on the patient and the characteristics of the IUD