Laparoscopic retrieval of a levonorgestrel intrauterine device in a patient presenting with abdominal pain

Uterine perforation is a potentially serious uncommon complication of intrauterine device (IUD) use. It has an incidence of one in 1000 insertions. It can manifest with abnormal uterine bleeding and pain. The most common site of implantation is the omentum. Risk factors include breastfeeding, <6 months postpartum, lack of experience of the healthcare professional, congenital uterine anomalies and nulliparity. Transvaginal ultrasound scan (USS) is accurate in localisation of the Mirena IUD. If the IUD is not evident within the uterus, an abdominal radiograph should be performed. Laparoscopic surgery is the preferred method for successfully removing a malpositioned device. The authors present the case of a multiparous woman in her early 20s presenting with abdominal pain and ‘lost’ Mirena IUD threads. A pelvic USS showed no evidence of an IUD inside the uterus. An abdominal radiograph confirmed the IUD in the pelvis. The IUD was removed laparoscopically and her abdominal pain resolved. This case provides a cautionary reminder that a migrated IUD may cause abdominal pain.