Entrapment of the intrauterine device removing hook during difficult Mirena removal: a case report
Year: 2025
Type: article
Study design: Case Report
Abstract: Mirena (levonorgestrel-releasing intrauterine system) is a widely used long-acting reversible contraceptive known for its efficacy and safety in both contraception and management of heavy menstrual bleeding. While routine removals are typically straightforward, various anatomical and technical challenges can complicate the procedure. We present a rare case of mechanical entrapment of an intrauterine device (IUD) removing hook during attempted retrieval of a Mirena device in a 45-year-old multiparous woman. The patient presented for elective Mirena removal after six years of use. On examination, the IUD threads were not visible, and transvaginal ultrasound confirmed that the device was correctly positioned within the uterine cavity. During attempted removal using a standard IUD hook, resistance was encountered, and the instrument became entrapped within the cervical canal. After the initial attempts at gentle manipulation failed, the procedure was paused to reassess the situation. Transvaginal ultrasound ruled out perforation, but suggested cervical stenosis as a likely contributing factor. To facilitate cervical dilation, 200 mcg of misoprostol were administered vaginally. Four hours later, with the cervix softened and partially dilated, the hook was successfully removed under local anesthesia. Subsequently, the Mirena was retrieved using hysteroscopic graspers under ultrasound guidance without complications. This case highlights the importance of a calm, stepwise approach when managing difficult IUD removals. It also emphasizes the utility of misoprostol for cervical priming and the role of ultrasound and hysteroscopy in safely navigating complex cases. Instrument entrapment is a rare but important complication that clinicians should be aware of, especially in patients with suspected cervical stenosis or prior uterine surgery. Recognizing early signs of resistance and avoiding forceful extraction are crucial to prevent iatrogenic trauma.
Source: Ginecologia ro
Authors: Smit Bharat Solanki, Aishwarya Singh Rathore, Sahil Patel
Institution: Ahmedabad Civil Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415501433
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