Anterior cervical perforation by levonorgestrel-releasing intrauterine device threads with preserved intrauterine position: A case report.

A 42-year-old woman presented for routine gynecological evaluation without symptoms. During speculum examination, the threads of a 19.5 mg levonorgestrel-releasing intrauterine device (LNG-IUD) were observed emerging through the anterior cervical lip outside the endocervical canal. Three-dimensional transvaginal ultrasound confirmed correct positioning of the LNG-IUD within the uterine cavity despite the anomalous thread trajectory. After intracervical local anesthesia, the exteriorized thread segment was sectioned to release the transfixing tract, and the device was successfully removed under ultrasound guidance using Hartmann forceps without complications. The patient remained asymptomatic during follow-up. This case highlights that visible LNG-IUD threads do not always indicate normal endocervical positioning and emphasizes the importance of careful gynecological examination and three-dimensional transvaginal ultrasound evaluation for diagnosis and management.