Vesical calculus formation around a migrated Copper-T 280a

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.

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