Radiological accuracy in locating a migrated IUD from the uterine cavity

Abstract

The Intra Uterine Device (IUD) is a safe and common form of contraception. Locating a lost IUD following silent perforation of the uterus  either during or after IUD insertion is challenging. Locating the IUD using radiological investigation is straightforward. However, the use  of a series of radiological investigations which brings the same management outcome is controversial in terms of cost. This is a report of  a rare case in which several radiological investigations were conducted following IUD migration from the uterine cavity. The patient  presented with lower abdominal pain and dyspareunia for oneyear post IUD insertion. Plain pelvic X-ray has less diagnostic accuracy in locating a migrated IUD compared to pelvic ultrasound and pelvic Computer Tomography (CT). Although it is cheap and can be done in  low resource areas where there is minimal health investment it should be used as a preliminary investigation in case pelvic ultrasound is  not available. This case report shows the important role of different imaging modalities, depending on cost, infrastructure, availability of  radiological expertise, and the timely availability of endoscopic services, in diagnosing and managing a displaced IUD compared to open  surgery.