An Enigmatic Case of Rectal Bleeding in a Young Woman-A Forgotten Intrauterine Device, Perforation and Rectal Involvement: A Case Report and Literature Review.

Background

Perforation associated with intrauterine devices (IUDs) occurs in approximately 1 in 1000 insertions and may be either partial or complete. Perforation may be primary, occurring during device insertion, or secondary, developing after the device has remained in situ for more than eight weeks. Typical symptoms of IUD perforation include chronic pain and intestinal obstruction. Rarely, the device is found either completely within the rectal lumen or partially embedded in the rectal wall with partial intraluminal extension. Removal of the device may require colonoscopy, laparoscopy, or a combination of both. Case: A 45-year-old woman was referred for evaluation of intermittent rectal bleeding. Initial outpatient evaluation included contrast-enhanced computed tomography (CT), which demonstrated two intrauterine devices: one appropriately positioned within the uterine cavity and another located within the rectouterine pouch. A multidisciplinary discussion involving gastroenterologists, gynecologists, and colorectal surgeons was subsequently conducted. Under general anesthesia, laparoscopy was initiated. Upon entering the abdominal cavity, a free IUD string was visualized embedded within the pelvic peritoneum. Using simultaneous colonoscopic guidance with transillumination, a targeted peritoneal incision was made overlying the IUD. The arms were removed laparoscopically. Subsequent colonoscopy removed the remaining segment of the IUD traversing the rectal wall.

Conclusions

Although uterine perforation and migration of intrauterine devices are uncommon, they may result in severe and potentially life-threatening complications. Early diagnosis, careful documentation, routine follow-up, and timely removal of misplaced devices remain essential to minimizing morbidity and preventing adverse outcomes.