Womans IUD worked it's way into her bladder. A 26-year-old female patient from a rural area presented with chronic abdominal pain for 2 years. The pain was located over the whole lower abdomen, coming on and off, relieved by medication. She also had on-and-off vomiting and pain during micturition for 6 months once in 2-3 weeks. She had a history of IUD insertion 2 years back after her second child.
Vitals were stable. Examination of abdomen showed mild distension in the lower abdomen, with exaggerated bowel sounds. Clinical suspicion of subacute intestinal obstruction was made and the patient was investigated.
Erect x-ray showed few air-fluid levels in the RIF and epigastrium and a radioopaque structure was noted in the pelvis. USG of the abdomen revealed a bladder stone of 6 x 5cm with extention of an IUD-like structure into the posterior wall. Gynaecologocal opinion revealed absence of tail of IUD. CT of the abdomen and pelvis revealed a complex mass in the pelvis consisting of small bowel, large bowel, bladder and uterus.
Laparotomy was planned. Exploration revealed a mass consisting of ileum, sigmoid and omentum covering the pelvis, with narrowing of ileal lumen by adhesion. These adhesions were freed meticulously and the pelvis was reached. An IUD coming out of the uterus and entering the baldder was noted. The bladder was opened to see a stone with the IUD embedded inside it. The stone with the IUD was removed. The bladder wall was sutured. Hemostasis was achieved, drains were inserted and the wounds were sutured.