Delayed extrauterine copper IUD identified 1 month after repeat insertion in a woman with multiple sclerosis: a case report
4 affiliations
- 1Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- 2Medical Department, Mazandaran University of Medical Sciences, Sari, Iran
- 3Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- 4Department of Fellowship and Subspeciality Level, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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.
Presentation 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.
Clinical 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.
Conclusion:: 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.
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BibTeX
@article{kiani2026delayed,
title = {{Delayed extrauterine copper IUD identified 1 month after repeat insertion in a woman with multiple sclerosis: a case report}},
author = {Fakhroddin Kiani and Abbas Alibakhshi and Nima Amini and Nafiseh Shabani Mofrad and Abdul Latif Abid and Omid Rezaei},
journal = {International Journal of Surgery Case Reports},
year = {2026},
month = oct,
doi = {10.1097/rc9.0000000000001141},
url = {https://doi.org/10.1097/rc9.0000000000001141},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - Delayed extrauterine copper IUD identified 1 month after repeat insertion in a woman with multiple sclerosis: a case report
AU - Fakhroddin Kiani
AU - Abbas Alibakhshi
AU - Nima Amini
AU - Nafiseh Shabani Mofrad
AU - Abdul Latif Abid
AU - Omid Rezaei
PY - 2026
DA - 2026/10/09
JO - International Journal of Surgery Case Reports
DO - 10.1097/rc9.0000000000001141
UR - https://doi.org/10.1097/rc9.0000000000001141
AB - 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. Presentation 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. Clinical 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. Conclusion:: 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.
SN - 2210-2612
ER -