Laparoscopic Management of an Intrauterine Device Perforating the Uterus and Adherent to the Rectum and Ovary: A Case Report

TL;DR

A 31-year-old woman had a complex IUD perforation requiring robotic-assisted laparoscopic removal with help from multiple surgical teams.

Contribution

This case report describes a multidisciplinary robotic-assisted approach for complex IUD perforation involving pelvic organs.

Findings

The IUD was successfully removed intact with robotic assistance and collaboration from gynecologic oncology and colorectal surgery.

The patient's symptoms resolved postoperatively without complications.

Such robotic-assisted management of complex IUD migration is rarely documented in the literature.

Abstract

Management of intrauterine device (IUD) perforation can be complex when adjacent pelvic organs are involved. Laparoscopic removal is commonly performed; however, cases involving bowel adherence may require intraoperative assistance from additional surgical services. We report the case of a 31-year-old gravida 2, para 2 (G2P2) woman with a history of cesarean delivery who presented with pelvic pain five weeks postpartum and was found to have an IUD perforating the posterior uterine wall, with adherence to the rectum and left ovary. The patient underwent robotic-assisted laparoscopic removal of the IUD. Gynecologic oncology was consulted intraoperatively due to availability and expertise in pelvic dissection to assist with the removal of the IUD from the colon, in collaboration with colorectal surgery. The device was removed intact; associated uterine and rectal defects were repaired, and hemostasis was achieved. The postoperative course was uncomplicated, with complete resolution of symptoms. Published literature describing robotic-assisted approaches for complex IUD perforation involving adjacent pelvic organs remains limited. This case contributes descriptive clinical experience regarding multidisciplinary, robotic-assisted management of complicated IUD migration.

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