Contraception 91 (2015) 430

Letter to the Editor Hematochezia caused by intrauterine device perforation☆

To the Editor: We read with interest the article on the safe removal of an intrauterine device (IUD) that had perforated the rectum when a rectal approach was used [1]. In contrast, our case of perforation caused by an IUD had serious results. We report the laparoscopic findings and history of our patient to increase awareness of the potential adverse outcomes of IUD migration. A 53-year-old postmenopausal woman was transferred from a local clinic with hematochezia 1 month in duration. She had no history of previous surgery or medication for hypertension or hypothyroidism. An IUD had been inserted 5 years earlier. The ultrasonographic findings revealed an atrophic uterus lacking the IUD. Colonoscopic findings revealed a bleeding focus with erythematous mucosa and hemorrhagic spots 20 cm from the anus. Computed tomography (CT) scans showed that the IUD had migrated to the neighboring rectosigmoid junction, and the laparoscopic findings revealed severe bowel adhesion to the left cornual side of uterus (Fig. 1). We performed a laparoscopic colectomy 10.5 cm in length and 6.5 cm in diameter. The pathological findings revealed perforation with peritonitis and foreign-body reactions; see note in colectomy site and reactive hyperplasia of the lymph node. The IUD was

safely removed via a rectal approach in the case reported by Eichengreen and colleagues [1]; however, our patient required colectomy to manage the perforated bowel and severe adhesion. We agree with the cited authors that laparoscopic exploration and CT scans are indicated, as we found it difficult to locate the IUD during laparoscopy. IUD-mediated perforation of the bowel is rare; however, IUD migration should be considered in patients presenting with abdominal pain and bowel symptoms such as hematochezia.

Acknowledgments This work was supported in part by the Soonchunhyang University Research Fund.

Tae-Hee Kim Hae-Hyeog Lee⁎ Soo-Ho Chung Dong-Su Jeon Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, 420-767 Republic of Korea ⁎Corresponding author at: Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-767, Republic of Korea Tel.: + 82 10 5273 7840; fax: + 82 2 6008 6874 E-mail address: [email protected] http://dx.doi.org/10.1016/j.contraception.2015.01.019 Reference

Fig. 1. The laparoscopic findings revealed severe bowel adhesion to the left cornual side of uterus. ☆

Conflict of interest: none.

0010-7824/© 2015 Published by Elsevier Inc.

[1] Eichengreen C, Landwehr H, Goldthwaite L, Tocce K. Rectal perforation with an intrauterine device: a case report. Contraception 2014, http://dx.doi.org/10.1016/j.contraception.2014.12.004 [Epub ahead of print].

Hematochezia caused by intrauterine device perforation.

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