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CASE REPORT
Laparoscopic Retrieval of a Displaced Intrauterine Device

Presenting as Umbilicus Sinus

2
1
Diwakar Sahu , Kislaya Kumar Sao , Shiv Shankar Dubey 3
AbstrAct
Aim: To report a case of displaced intrauterine device (IUD), having unusual presentation, and signify the role of laparoscopy in the surgical
management of migrated IUD.
Background: The IUD is a popular family planning method worldwide. Intrauterine device migration into the peritoneal cavity is a serious
complication and requires surgical removal in the majority of cases. In most of the reported cases, retrieval was performed through laparotomy.
Moreover, cases which were attempted laparoscopically, many of them later converted to open. Also, previously published articles have
mentioned migration of IUD into rectosigmoid, urinary bladder, small intestine, iliac vessels, and other sites. Ours is a probably first reported
case of displaced IUD presenting as discharging umbilical sinus and surgical retrieval performed via laparoscopic approach.
Case description: A 28-year-old woman presented with pain and discharge from umbilicus. Investigations revealed displaced IUD at the level
of umbilicus. Patient underwent laparoscopy surgery and found to have displaced IUD, embedded in-between omental adhesion to umbilicus.
Entire surgery was carried out laparoscopically and IUD removed. Patient had uneventful recovery after surgery.
Conclusion: Uterine perforation following IUD insertion is a rare but potentially serious complication. Accurate preoperative localization of
displaced IUD is obligatory and helpful. Current practice is to surgically remove all displaced IUDs. Laparoscopic approach appears to be safe
with advantage of faster recovery and good cosmesis.
Clinical significance: Our article will provide insight in erratic presentation of displaced IUD and further augment the role of laparoscopy in
the management of such cases.
Keywords: Copper-T, Intrauterine device, Laparoscopy.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1404

bAckground 1 Minimal Access Surgery Division, Late Kartik Ram Sao Memorial
Intrauterine device (IUD) is one of the most preferred contraception Hospital, Bilaspur, Chhattisgarh, India
methods used worldwide due to low cost, reversibility, and long- 2 Department of Surgery, Late Kartik Ram Sao Memorial Hospital,
lasting effect. Intrauterine device displacement and migration Bilaspur, Chhattisgarh, India
into the peritoneal cavity is a known and grave complication. The 3 Department of Anesthesia, Late Kartik Ram Sao Memorial Hospital,
frequency of uterine perforation and IUD displacement ranges Bilaspur, Chhattisgarh, India
1
from 0.2 to 9.6 per thousand insertions. Displaced IUD is a surgical Corresponding Author: Diwakar Sahu, Minimal Access Surgery
emergency and requires prompt removal soon after diagnosis. Division, Late Kartik Ram Sao Memorial Hospital, Bilaspur, Chhattisgarh,
Conventional approach is through laparotomy but numerous recent India, Phone: +91 7898492836, e-mail: diwakargmcbhopal@rediffmail.
reports have described laparoscopy as a preferred technique. 2,3 com
To the best of our knowledge, we report the first case of an How to cite this article: Sahu D, Sao KK, Dubey SS. Laparoscopic
IUD displacement presenting as umbilical sinus and was managed Retrieval of a Displaced Intrauterine Device Presenting as Umbilicus
successfully using laparoscopic approach. Sinus. World J Lap Surg 2020;13(2):87–89.
Source of support: Nil

cAse description Conflict of interest: None
A 28-year-old woman, parity and gravid 2, presented with pain
and discharge from umbilicus since 3 months. Discharge was occurred during or after surgery and patient discharged on day 3
intermittent, serous in nature, mild in quantity and associated postoperatively. Patient follow-up period was uneventful.
with throbbing pain, and erythema around umbilicus. Patient had
a history of IUD (Copper-T A380) insertion 3 years ago, but strings discussion
were missing since 8 months. Patient underwent ultrasound
and X-ray abdomen which showed foreign body at the level of Intrauterine devices are effective and reversible contraceptive
umbilicus (Fig. 1). Routine blood investigation was performed method, especially in developing countries. Though considered
which were within normal limit. She was subjected to laparoscopy safe, IUD insertions are associated with several complications, such
surgery which showed omental adhesion just beneath umbilicus. as abdominal pain, infection, ectopic pregnancy, menorrhagia,
2
Adhesions were released partially, revealing Copper-T entangled and uterus perforation. Displaced IUDs may lead to perforation
within adhesions. Further sharp and blunt dissection was carried of adjoining organs, such as rectum, colon, small intestine,
out, thereby removing Copper-T (Fig. 2). No complications urinary bladder, and very rarely appendix. 4–6 Migration of IUD

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