Laparoscopic removal of a migrated copper IUD causing pelvic abscess: a case report

Introduction: Intrauterine device (IUD) migration is a rare but potentially serious complication that can cause pelvic abscess, chronic pain, and infertility. Prompt diagnosis and management are essential. This case highlights the laparoscopic removal of a migrated copper IUD causing a pelvic abscess, demonstrating minimally invasive management and fertility preservation in a rare scenario. Case presentation: A 27-year-old woman presented with 2 months of intermittent suprapubic pain and dysuria. Her copper IUD, inserted 1 year earlier, had non-palpable threads for several months. Examination revealed mild right lower quadrant tenderness. Laboratory tests showed elevated C-reactive protein with normal leukocyte count. Ultrasound and contrast-enhanced CT revealed an extrauterine IUD embedded within a pelvic inflammatory mass adjacent to the bladder. Laparoscopy identified dense adhesions and a chronic abscess containing the IUD, which was removed along with surrounding fibrotic tissue. Postoperative recovery was uneventful, and culture grew Escherichia coli, treated with targeted antibiotics. Discussion: This case emphasizes the importance of cross-sectional imaging for accurate localization of migrated IUDs and surgical planning. Laparoscopic retrieval provides safe, definitive management with minimal morbidity. 5-year follow-up confirmed preserved fertility, with two full-term pregnancies. Conclusion: Extrauterine IUD migration should be considered in women with pelvic pain and missing threads. CT imaging is essential, and laparoscopic retrieval remains the standard of care, offering favorable outcomes, including fertility preservation.