Finding its way out on its own - the story of a misplaced IUCD

Abstract

Misplaced IUCD is defined as the condition when the tail of the IUCD is not seen through the os. The  presentation varies widely and a high index of suspicion is required for diagnosis. This is a 26 years old patient who underwent emergency repeat caesarean section with post placental IUCD insertion 6 months ago. She had gestational diabetes requiring insulin antenatally and had postoperative wound infection. The patient was not on regular follow up and presented 6 months later with complaints of serous discharge from the wound site for past 5 months and complaints of pain over the lower abdomen for the past few days. One week later she developed a discharging sinus infraumbilically. IUCD tail was not seen and on further evaluation IUCD was found to perforate the anterior uterine wall. Laparoscopy was not done as patient was found to have dense abdominal adhesions during caesarean section. On laparotomy, uterus was  adherent to the anterior abdominal wall, tip of IUCD was seen perforating through the fundus on the left side with bowel adhesions. The same released and IUCD removed. This case reflects the importance of follow up post IUCD insertion and the need to evaluate for misplaced IUCD when tail is not  visualised. Also, the discharging sinus in this case provided a valuable clue without which this patient may have been treated for chronic wound infection alone.