Vesical calculus formation around a migrated Copper-T 280a
S. Dede, B. Dilbaz, D.Sahin
Department of Endoscopic Surgery, SSK Maternity and Women’s Health
Teaching Hospital, Ankara, Turkey
The most widely used contraceptive method in Turkey has been intrauterine
device during the last 15 years. Perforation of the uterine wall with
intrauterine device (IUD) and migration of the device into the pelvic or
abdominal cavity or adjacent organs is a major but uncommon complication seen
with an incidence rate of 0.87 per 1000 insertions. This complication occurs
most frequently at the time of insertion but may also occur later following an
incomplete perforation and migration. A case with perforation of the uterus and
migration of the intrauterine device to the urinary bladder with secondary
vesical stone formation is presented. A 28 –years old patient was admitted for
IUD removal after the threads of the IUD could not be found during the speculum
examination. Pelvic X-ray and transvaginal ultrasonograpy demonstrated the
presence of the IUD outside the cavity but with a close neighbouring to the
myometrial layer of the anterior wall of the uterus at a lower level.
Hysteroscopic examination showed a normal intact endometrium with no sign of the
IUD, and laparoscopic examination showed a thick omental adhesion obliterating
the lower segment of the uterus. After adhesiolysis the thread and the stalk of
the IUD was removed. An onsite transport pelvic X-Ray was taken showing the
missing arms inside the pelvic cavity. Cystoscopic examination showed the
missing arms inside the urinary bladder with the presence of vesical calculus
formation around the arms and removal was performed using a forceps.
Postoperative follow-up was uneventful. Insertion of the IUD must be carried out
by trained staff and patients should be encouraged to come for routine follow-up
visits. Radiologic work-out must be carried out liberally when ever there is a
suspicion of complete or incomplete perforation.
