Intestinal Perforation by a Migrated Intrauterine Contraceptive Device: A Review of This Rare but Important Complication

Intrauterine contraceptive devices (IUCDs) are one of the most popular forms of modern contraception. We present a case of IUCD migration into the sigmoid colon and associated abscess formation, with a literature review to aid surgeons in recognising, investigating and treating this rare complication. This is the most comprehensive known review of this subject to date. PRISMA guidelines were used. All case reports published up until the 15th March 2020 were included, if they described migration of a modern T-shaped IUCD relating to or penetrating intestinal viscera. Fifty-two cases were suitable for inclusion. Abdominal pain (48.9%) and failure of contraceptive effect (42.6%) were non-specific but common presentations. Laparoscopic retrieval was frequently attempted, but with relatively low success rates. Adhesions, visceral involvement and abscesses were associated with failure, conversion to open surgery, bowel resection and stoma formation. Asymptomatic migration was likely to be underestimated and presents an argument for non-operative management, although not currently recommended by national and international guidelines. Although limited by reporting biases and the small number of cases available, our review highlights that diagnosis requires a high index of suspicion, regardless of menstrual status. It also demonstrates the importance of cross-sectional imaging prior to management, balanced with the risks of radiation exposure, to allow informed consent and avoid failed retrievals.