BACKGROUND: For the most part, intrauterine devices (IUDs) have a low complication rate and minimal side effects. However, one of the most common reasons for contraceptive failure while using an IUD is its translocation or extrauterine migration. Pregnancy complicated by translocation or an ectopic IUD can present a formidable clinical challenge. CASE: A 23-year-old woman, gravida 3, para 2, using a copper-7 IUD for contraception, presented at 7 weeks' gestation. Transvaginal sonogram confirmed the presence of a fetal pole with cardiac activity; however, the IUD was not detectable. An anteroposterior roentgenogram showed 90 degrees counterclockwise rotation of the IUD relative to the normal position. Laparoscopy was performed at 14 weeks. The IUD was extrauterine, buried in omental adhesions attached to the anterior abdominal wall. The IUD was dissected free and removed without difficulty. The remainder of the pregnancy was uncomplicated. CONCLUSION: Uterine perforation is a recognized and potentially hazardous complication of IUD use. Localization of a lost IUD should follow an organized and systematic approach utilizing an assortment of radiologic and operative techniques. We report the third known case utilizing laparoscopy to remove an ectopic IUD complicating early pregnancy. Laparoscopy, even during pregnancy, has proven to be a safe and simple tool for managing a variety of surgical conditions.
BACKGROUND: For the most part, intrauterine devices (IUDs) have a low complication rate and minimal side effects. However, one of the most common reasons for contraceptive failure while using an IUD is its translocation or extrauterine migration. Pregnancy complicated by translocation or an ectopic IUD can present a formidable clinical challenge. CASE: A 23-year-old woman, gravida 3, para 2, using a copper-7 IUD for contraception, presented at 7 weeks' gestation. Transvaginal sonogram confirmed the presence of a fetal pole with cardiac activity; however, the IUD was not detectable. An anteroposterior roentgenogram showed 90 degrees counterclockwise rotation of the IUD relative to the normal position. Laparoscopy was performed at 14 weeks. The IUD was extrauterine, buried in omental adhesions attached to the anterior abdominal wall. The IUD was dissected free and removed without difficulty. The remainder of the pregnancy was uncomplicated. CONCLUSION: Uterine perforation is a recognized and potentially hazardous complication of IUD use. Localization of a lost IUD should follow an organized and systematic approach utilizing an assortment of radiologic and operative techniques. We report the third known case utilizing laparoscopy to remove an ectopic IUD complicating early pregnancy. Laparoscopy, even during pregnancy, has proven to be a safe and simple tool for managing a variety of surgical conditions.