Delayed extrauterine copper IUD identified 1 month after repeat insertion in a woman with multiple sclerosis: a case report
Year: 2026
Type: article
Study design: Case Report
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.
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,090
OpenAlex ID: W7225731385