TALES OF WANDERING INTRAUTERINE DEVICE (IUD) STRINGS AND ITS MANAGEMENT: A CASE SERIES

Abstract

Abstract

Introduction: Intrauterine devices (IUDs) are effective contraceptive methods with a pregnancy prevention rate of 99%. Although generally safe, complications such as perforation and migration can occur, leading to significant morbidity if not addressed promptly. This case series aims to discuss the clinical presentations and management strategies for patients with missing IUD strings.

Methods: This study examined 10 cases of missing IUD strings presented at RL Jalappa Hospital between January 2022 and December 2023. Data was collected retrospectively, focusing on patient demographics, clinical symptoms, diagnostic findings, and management strategies. Diagnostic modalities included ultrasound and X-rays, while management varied from conservative approaches to surgical interventions based on the extent of IUD migration or perforation.

Results: Out of the 10 cases, 8 involved copper-T IUDs, and 1 case involved a levonorgestrel-releasing IUD (Mirena). Five cases with copper-T IUDs presented with perforation, requiring exploratory laparotomy and surgical removal. Two cases were managed conservatively with IUD removal through artery forceps under ultrasound guidance. One patient with a Mirena IUD required a total abdominal hysterectomy due to severe uterine bleeding and fibroid displacement. One patient with an extrauterine copper-T did not return for planned laparoscopic removal. Most patients experienced uneventful postoperative recoveries, with one patient lost to follow-up.

Discussion: The case series highlights the variable clinical presentations of missing IUD strings, ranging from mild discomfort to severe complications like bowel perforation. Timely diagnosis using ultrasound and appropriate intervention are critical for preventing further complications. Surgical removal was often necessary in cases of migration and perforation, while conservative methods were sufficient in cases without perforation. This underscores the need for individualized management.

Conclusion: Missing IUD strings can indicate migration or perforation, leading to potentially serious complications. Prompt recognition, appropriate imaging, and individualized treatment strategies are crucial for ensuring optimal outcomes. Patient education on IUD follow-up and vigilance in monitoring symptoms are essential to minimizing risks.