P1285 - Intrauterine Device (IUD) Migration Into Sigmoid Colon

anuj S. Shah, MBBS¹, Pranav Patel, MD^2
1Revere, Boston, MA; ²University of Alabama at Birmingham, Montgomery, AL

Introduction:

Intrauterine device is safe and convenient method for contraception. IUD migration into colon is a rare but a serious complication. Our case report describes how it can be managed endoscopically without need for any other surgical interventions.

Case Description/Methods: 55-year-old South Asian woman presents for an elective outpatient colonoscopy for average risk screening. Informed consent was obtained from the patient and procedure was performed.

Upon colonoscopy, cecum, ascending colon, transverse colon, descending colon, and rectum appeared to be normal but a foreign body was noted in the sigmoid colon. The foreign body which turned out to be an Intrauterine device (Copper T). The IUD was embedded in the sigmoid colon with the vertical arm seen intraluminal but the horizontal arm was extraluminal. Mucosa was carefully examined around the site of the embedded IUD and simple snare removal with gentle pulling of IUD was done and was removed.

Patient tolerated the procedure well and no post procedural complication was noted. Patient followed up 2 weeks after procedure and no delayed complications were noted as well.

When the patient was asked about history of placement of an Intrauterine device, patient reported history of placement of Copper T by her family physician approximately 35 years ago and she got pregnant a few years after that, on her checkup she was informed by her gynecologist that the Copper T must have fallen off. Patient had 2 kids since then.

Discussion: The Intrauterine device (IUD) is a safe, effective, convenient method for contraception. The presence of IUD in the gastrointestinal tract could be because of uterine perforation or misplaced IUD. Ectopic IUD can present with delayed abdominal pain or irregular vaginal bleeding but many women with extrauterine IUDs can be asymptomatic too.

Sigmoid colon is the most common site in the colon where an extrauterine IUD could be found. A few reports have been reported earlier on the presence of IUD in the colon which required surgical intervention. Our is one of the first reported case in which IUD was removed colonoscopically without surgical intervention. We believe that the fibrosis and adhesions due to passage of IUD from uterus to colon over a long time was the likely reason that prevented free perforation. Proper and detailed history of such patients would help to plan less invasive interventions and possibly help prevent surgical interventions.



Disclosures:


anuj S. Shah, MBBS¹, Pranav Patel, MD². P1285 - Intrauterine Device (IUD) Migration Into Sigmoid Colon, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.