Appendicitis caused by an intra-uterine contraceptive device

A case of acute appendicitis in a 26-year-old woman apparently caused by a Copper-T IUD inserted 4 years previously is reported. Only 6 previous cases of this rare complication are recorded in the world literature. The woman was admitted as an emergency with a 12 hour history of epigastric pain radiating to the right iliac fossa and right lumbar region and associated with nausea and vomiting. The woman had had 2 children and 1 miscarriage. At admission her axillary temperature was 37.6 degrees Centigrade and her rectal temperature was 38.8 degrees Centigrade. She was tender in the right iliac fossa. On vaginal examination she was noted to have an IUD in situ. The woman had become pregnant and an abortion was performed. The IUD was not recovered. The possibility that the IUD had perforated the uterus was not considered, and 1 month following the termination a 2nd IUD (a Lippes Loop) was inserted. A diagnosis of acute appendicitis was made. The abdomen was opened through a McBurney incision. There was an inflammatory mass which included omentum involving the appendix with dense adhesions to the caecum. After dissection, a short and inflamed appendix was found with an IUD emerging from its proximal third. An appendectomy was performed. The right tube and ovary were noted to be mildly inflamed. The uterus appeared normal. No perforation site was observed, and the abdomen was closed. In this case it seemed likely that the IUD had perforated the uterus at the time of its initial insertion. The manner in which the device reached the appendix is unknown. In any instance of a "missing" IUD, an abdominal X-ray, ultrasound, or hysterography is indicated to exclude perforation and/or migration. If perforation of the uterus has occurred, the IUD should be recovered either by laparoscopy or, if necessary, laparotomy.