CASE HISTORY – December 2022

Perforation of a hormonal intrauterine device into the sigmoid colon: a case report

Authors: Ülle Kiisla, Piret Sinimäe

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Perforation of intrauterine device (IUD) is a rare complication of IUD insertion. Perforations can be either partial or complete
and most of them happen during insertion. Partial perforation can remain as such or it may convert to complete perforation within
days, weeks or months.

In most cases, perforation is not recognized at the time of IUD insertion. Perforations should definitely be suspected if the patient feels acute pain during placement or right after it.
The 41-year-old patient reported here had undergone hormonal IUD placement 4.5 years earlier. She had been asymptomatic the
whole time, but developed suddenly painful urination, and lower back and abdominal pain. A CT scan of the abdomen showed an
opaque shadow, resembling an IUD, which was connecting the uterus and the sigmoid colon. There were no signs of acute process –neither free gas or fluid in the abdomen.
A laparoscopic removal of the IUD was performed, during which a fistula was found between the uterus and the sigmoid colon,
caused by the perforated IUD.
The IUD was removed vaginally and the fistula was corrected. The patient had no complications and she opted for tubal sterilization for her contraception method.