Delayed diagnosis of concurrent intrauterine and intraperitoneal intrauterine devices following assumed expulsion: A case report

Introduction: Intrauterine devices (IUDs) are effective long-term contraceptives. Although rare, IUD migration can lead to severe complications if undiagnosed. Migration may present with pain, or remain asymptomatic, and unvisualized devices are often presumed expelled without confirmation. Case presentation: A 40-year-old African female, Para 2 Living 2, presented with a two-week history of intermittent dull right lower abdominal pain and a history of heavy menstrual bleeding managed with a myomectomy and contraceptive methods. A copper IUD (Cu-IUD) was inserted ten years prior to presentation but presumed expelled after it was not visualized on ultrasound two years later. A year after this, the patient reported that a Mirena IUD had been inserted without complications. One year before the current admission, a CT scan performed elsewhere during evaluation for hip and leg pain incidentally revealed two IUDs within the uterus. She was reassured and took no further action. Current imaging showed a migrated IUD near the urachal ligament and another device correctly positioned in the uterus. The patient underwent exploratory laparotomy to retrieve the migrated IUD and elective hysterectomy for abnormal uterine bleeding. Her postoperative recovery was uneventful. Discussion: IUD migration, though rare, can cause pain, perforation, and infection. Failure to confirm expulsion may result in undiagnosed complications. This case highlights the importance of clinical suspicion and imaging when an IUD is unvisualized. Conclusion: Unvisualised IUD warrants thorough evaluation. This case underscores the necessity of confirmatory imaging in cases of unvisualised IUDs to prevent delayed diagnosis and complications.