Migrated Intrauterine Contraceptive Device Associated With Appendicitis

Abstract

The objective of this study was to systematically review the published literature on intrauterine contraceptive device (IUCD)-associated appendicitis, focusing on the IUCD type involved, operative findings, clinical presentation, management strategies, and outcomes. A 27-year-old woman presented with worsening lower abdominal pain and had undergone IUCD insertion 2 years earlier. Abdominal X-ray showed the IUCD in the right iliac fossa. Ultrasonography revealed a linear hypoechoic structure with surrounding inflammatory changes and increased vascularity in the right iliac fossa region. Diagnostic laparoscopy revealed adhesions over the anterior abdominal wall containing a misplaced copper T device. The appendix was inflamed, with one horizontal limb of the IUCD adherent to it. The device was removed laparoscopically, followed by appendectomy. A review of the relevant literature was conducted to compare similar reported cases. Of the 11 case reports reviewed in this study, 91% involved copper-containing IUCDs. Nine of 11 cases presented with lower abdominal pain. All the cases had an uneventful recovery. Clinicians should consider this possibility in patients with a missing IUCD who present with lower abdominal pain. This risk of uterine perforation following IUCD insertion could theoretically be higher in nulliparous women, but practically, the results differ. However, early operative management prevents further intra-abdominal complications.