Intraperitoneal Levonorgestrel-Releasing Intrauterine Device in a Patient With a Kidney Stone: A Case Report

TL;DR

A woman with a kidney stone was found to have an intrauterine device (IUD) that had migrated into her peritoneal cavity, which was safely removed through laparoscopic surgery.

Contribution

This case report highlights the rare occurrence of an intraperitoneal IUD migration and its successful laparoscopic retrieval.

Findings

The IUD was found freely floating in the peritoneal cavity with no signs of perforation or adhesions.

Laparoscopic retrieval was performed successfully without complications.

Intraperitoneal IUD migration can remain asymptomatic for years and may be safely removed laparoscopically.

Abstract

This report presents a rare case of a previously placed intrauterine device (IUD) subsequently found freely floating in the peritoneal cavity in a patient presenting with a kidney stone. A woman in her early 30s with a history of levonorgestrel IUD placement four years prior presented to the emergency department with sudden-onset, sharp, severe left lower quadrant pain. A CT scan demonstrated a 5 mm obstructing ureteral stone in the distal left ureter as well as an IUD in the inferior peritoneal cavity with no free air or bowel injury. This case, in the context of current literature surrounding migrated and perforated IUDs, is evaluated and presented in the following report. The device was successfully retrieved laparoscopically without incident. Intraoperative inspection showed no uterine perforation at the time of laparoscopy, no adhesions, and no involvement of adjacent structures or organs. Postoperative follow-up was conducted to assess recovery and symptom resolution. Intraperitoneal migration of IUDs, although rare, can occur and may remain asymptomatic for several years. Migration may be complicated by adhesions, perforation, and infection. However, ectopic IUDs may alternatively be free-floating in the peritoneal cavity without complications. Laparoscopic retrieval is safe and effective, and this can be considered the preferred method of retrieval in most cases.

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