IUD Malposition at the Internal Iliac Vessels
The present case report appears in the recent issue of The Journal of Minimally Invasive Gynecology.

A 42-year-old woman presented with pain days after undergoing intraoperative Levonorgestrel 52 mg intrauterine device (IUD) placement at the time of hysteroscopy complicated by cervical stenosis. A computed tomography scan suggested an IUD within the myometrium versus the right pelvic sidewall. The IUD was not visualized on hysteroscopy or laparoscopy performed 1 month later, or on total abdominal hysterectomy performed 3 months later for persistent pain.

Magnetic resonance imaging (MRI) performed before hysterectomy suggested an intramural IUD; postoperative MRI showed an IUD in the pelvic sidewall along the course of the internal iliac vasculature, with a 1.5 × 1.2 × 1.4 cm hematoma at the inferior IUD tip.

Diagnostic laparoscopy performed 6 weeks after hysterectomy revealed the IUD embedded between the internal iliac artery and vein, with significant associated scarring and inflammation. Conversion to laparotomy was performed with vascular surgery consultation. The IUD was removed in fragments, with intraoperative fluoroscopy to confirm complete removal.

Read more here: https://www.jmig.org/article/S1553-4650(17)31092-0/fulltext
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