ABSTRACT

We present a case of a symptomatic perforation by an intrauterine device (IUD) into ileum resulted as a tubo-ovarian abscess. A 38-year old patient, who received TCu 380A in approximately 7 years ago, presented at the outpatient clinic with tubo-ovarian abscess. The patient received a 12-day course of antibiotic regimen intravenously. Clinical findings persisted despite upon antibiotic treatment. Then it was decided to operate the patient. Transvaginal ultrasound-guided drainage of tuboovarian abscess with concomitant hysteroscopy procedure was decided. Almost 200 mL of purulent, dense, brownish pus was drained until it was completely emptied and hysteroscopy was performed to remove the IUD. There was a negative pressure when aimed to pull out with the resectoscope, and gave a feeling that it was invaded into a visceral organ, therefore laparoscopy was performed . In exploratory laparoscopy, it was observed that ileum and sigmoid colon were conglomerated and attached densely on fundus, and cul-de-sac was totally obliterated. The two flexible side arms were embedded inside the ileum. It was decided to proceed to laparotomy. IUD was removed from the defect. 15 cm of ileum was resected, and loop ileostomy was performed. Clinical evaluation at monthly was uneventful and loop-ileostomy was closed at 3 months postoperative. Perforation of the uterus should be kept in mind in which IUDs are not visible in the uterine cavity.