AN INTRA-UTERINE DISPOSITIF (IUD) MIGRATEUR EN INTRARECTAL : A CASE REPORT

The intrauterine device (IUD) is considered one of the most effective and widelyused contraceptive methods in the world. The placement of an intra-uterine deviceis a common gesture in gynecological practice. It is not harmless and the occurrence of a uterine perforation can be serious. Intrauterine perforation is a rare complication, but the most serious. Few publications document the presence of IUD in the intravesicular, sigmoid or causing an appendicular perforation. We report a case of an IUD having migrated in to the rectum. This is a 34-year-old patient, with no previous history, with the notion of placing a copper IUD for 2 years.

The patient consults as part of the annual control of her intrauterine device, the clinical examination being with out particularity but the control ultrasound revealed a hyperechogenic image at the level of CDS of Douglas evoking migration of IUDs, confirmed on abdomen image without preparation. Exploratory laparoscopy was indicated, during which only the IUD thread was visible at the peritoneal cavity, the latter being inserted into the rectum between the muscular and mucosa. The patient did not bleed, a 3-month monitoring was initiated, during which the patient spontaneously expelled the IUD during a defecation. An abdomen without preparation allowed us to confirm the expulsion and the absence of complication. We emphasize through this observation and our literature review the importance of strict adherence to recommended measures before placing an IUD, but also the monitoring of the patient. Thus, performing an endovaginal ultrasound to study in particular the anatomy of the uterus before the insertion of the IUD is particularly interesting. Repeated examination immediately after and 4 to 12 weeksafter the IUD would allow early detection of complications. Exploratory laparoscopy allows the localization of the IUD in intraperitoneal when the perforation iscomplete, but also its removal in certain situations.