{
  "abstract": "Introduction and importance:: Missing strings following intrauterine device (IUD) insertion are a common clinical finding; however, misattribution of missing strings to spontaneous expulsion may delay the diagnosis of uterine perforation and extrauterine migration.\n\nPresentation of case:: A 35-year-old woman with relapsing–remitting multiple sclerosis (MS) presented in July 2024 with pelvic pain, 4 years after copper IUD insertion in August 2020. Missing strings were presumed to indicate expulsion, and a second IUD was placed in January 2025. Persistent pain subsequently prompted imaging, which revealed an IUD and a migrated extrauterine IUD within the left broad ligament. The extrauterine IUD was successfully removed laparoscopically.\n\nClinical discussion:: IUD-related uterine perforation is rare but may result in extrauterine migration. When IUD strings are not visible, pregnancy should be excluded, and imaging should be performed to confirm location. Laparoscopy is the preferred approach for extrauterine devices. Our case emphasizes that delayed imaging can postpone diagnosis and treatment.\n\nConclusion:: In patients with nonvisible IUD strings, pregnancy should first be excluded, and imaging should be obtained, with ultrasonography as the initial modality, followed by abdominal radiography or computed tomography (CT) if intrauterine location is not confirmed, to prevent missed uterine perforation and retained extrauterine devices. Copper IUDs remain acceptable for most individuals with MS (U.S. MEC Category 1). This case highlights the importance of an imaging-first algorithm, the utility of CT when ultrasonography suggests extrauterine migration, and the safety of laparoscopic retrieval.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran",
    "Medical Department, Mazandaran University of Medical Sciences, Sari, Iran",
    "Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran",
    "Department of Fellowship and Subspeciality Level, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Fakhroddin Kiani"
    },
    {
      "affs": [
        0
      ],
      "name": "Abbas Alibakhshi"
    },
    {
      "affs": [
        1
      ],
      "name": "Nima Amini"
    },
    {
      "affs": [
        2
      ],
      "name": "Nafiseh Shabani Mofrad"
    },
    {
      "affs": [
        3
      ],
      "name": "Abdul Latif Abid"
    },
    {
      "affs": [
        0
      ],
      "name": "Omid Rezaei",
      "orcid": "0009-0002-8566-2566"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6z70kg4ht95bj.bib",
  "cited_by": 0,
  "doi": "10.1097/rc9.0000000000001141",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13747433/",
  "id": "6z70kg4ht95bj",
  "issns": [
    "2210-2612"
  ],
  "landing_url": "https://doi.org/10.1097/rc9.0000000000001141",
  "language": "en",
  "licence": "CC-BY-NC-SA-4.0",
  "licence_label": "CC BY-NC-SA 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-sa/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2739|Reproductive Health and Contraception"
    ]
  ],
  "openalex": "W7225731385",
  "pdf_url": "https://europepmc.org/articles/PMC13747433?pdf=render",
  "pmcid": "PMC13747433",
  "pmid": "43006040",
  "published": "2026-10-09",
  "publisher": "Wolters Kluwer Health",
  "ris": "https://research.draconitic.com/paper/6z70kg4ht95bj.ris",
  "sources": [
    {
      "first_seen": "2026-11-12T12:23:29Z",
      "native_id": "PMC13747433",
      "source": "pmc",
      "url": "https://doi.org/10.1097/rc9.0000000000001141"
    },
    {
      "first_seen": "2026-11-12T15:22:43Z",
      "native_id": "MED:43006040",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/43006040"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Reproductive Health and Contraception",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Delayed extrauterine copper IUD identified 1 month after repeat insertion in a woman with multiple sclerosis: a case report",
  "title_text": "Delayed extrauterine copper IUD identified 1 month after repeat insertion in a woman with multiple sclerosis: a case report",
  "type": "peer-reviewed",
  "updated_at": "2026-11-13T12:24:18Z",
  "url": "https://research.draconitic.com/paper/6z70kg4ht95bj",
  "venue": "International Journal of Surgery Case Reports",
  "versions": []
}