Triple intrauterine devices: a rare case
A 43- year- old lady with six children was admitted due to pain in hypogastrium. She had been experiencing dysmenorrhea and menorrhagia for a year prior and worsened during the last three menstrual periods. She was recently diagnosed as type 2 diabetes mellitus at body mass index (BMI) 31 kg/m2 and maintained on oral hypoglycemic medications.

In the pelvic examination, there was an enlarged 16 weeks sized uterus with slight tenderness. There was adenomyosis together with IUD in the uterus and unremarkable adnexa in sonogram. She has also a wonderful pertinent history of three episodes of IUD insertions without removal. Initial placement was made after her second childbirth vaginally in 1991.

Within that same year, she unexpectedly became pregnant. She gave birth to her third child in 1992 and the second IUD was placed without any consultation with the healthcare provider. Less than 2 years after, in 1994, she delivered her fourth child, and the third IUD was inserted again.

The patient had no recollection of IUD removals nor expulsions. Information regarding the dates or proximity of deliveries with IUD placements was unavailable. With the provisional diagnosis of adenomyosis, the patient underwent total laparoscopic hysterectomy (TLH) and bilateral salpingectomy (BSO).

During operation, there was revealed a globularly enlarged uterus about 14 cm with a multiloaded Cu-IUD adherent to the right ovary and another IUD to the right posterolateral side of the uterus. There was no any complication and injury to adjacent structures.

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