Uterine perforation by a Copper 7 intrauterine contraceptive device with subsequent penetration of the appendix.

This case is presented of a 24-year old woman who came to an antenatal booking clinic following a 17-week period of amenorrhea and 10 months after her last pregnancy. A Copper 7 IUD had been inserted 8 weeks after the birth of her last child. Follow up visits after IUD insertion had shown no problems but an unplanned pregnancy followed and there was no evidence of an IUD within the uterus. When the infant was born no IUD was found although the uterine cavity was not explored. At laparoscopy the IUD was found to be embedded in omentum and apparently lying adjacent to the appendix but at laparotomy was seen to have penetrated the appendix wall. The appendix, IUD, and adherent omentum were removed and no site of uterine perforation was identified. Reported incidence of uterine perforation with IUDs varies from 1/350 to 1/2500 insertions. Copper containing devices are more often embedded in omentum than plastic devices and thus require laparotomy for removal. Intraperitoneal IUDs do not necessarily produce symptoms but may intrude on neighboring viscera such as the bladder or intestinal tract. Copper containing IUDs are known to cause irritation and although translocation may have occured at the time of insertion, appendiceal penetration was almost certainly a later event.