Strangulated Small Bowel Obstruction Caused by a Migrated Ring-Shaped Intrauterine Device: Two Case Reports and a Literature Review.

BACKGROUND Small bowel obstruction (SBO) is a common surgical emergency, most frequently caused by postoperative adhesions or hernias. SBO resulting from migration of an intrauterine device (IUD) is exceedingly rare but can be life‑threatening. CASE REPORT We present 2 cases of postmenopausal women with long-term IUD retention (>30 years) who developed acute abdominal pain and clinical signs of intestinal obstruction. Preoperative abdominal CT revealed dilated small bowel loops with surrounding fluid and inflammatory changes, along with an ectopic ring-shaped IUD through which a segment of ileum herniated. Emergency laparotomy confirmed a strangulated obstruction and necrotic bowel in both cases, which required segmental bowel resection and primary anastomosis. Postoperative recovery was uneventful in both patients. A review of the literature indicates that such complications predominantly occur in postmenopausal women. Prolonged device retention, particularly with O-shaped IUDs, is associated with older age at presentation. Progressive uterine atrophy and myometrial thinning after menopause increase the risk of chronic erosion and eventual perforation with intraperitoneal migration. If the IUD is not encapsulated by the omentum, it provides an opportunity for small bowel loops to herniate through its central opening, ultimately resulting in strangulated intestinal obstruction. CONCLUSIONS These cases highlight the importance of recognizing IUD migration as a rare cause of mechanical small bowel obstruction, especially in women with a remote history of IUD placement. Prompt imaging evaluation and timely surgical intervention are critical to prevent bowel ischemia and reduce morbidity.