Pelvic pain associated with an unsuspected intraomental intrauterine device placed 30 years earlier: a case report.

BACKGROUND

Recent-onset chronic pelvic pain thought to originate from an intraomental Dalkon Shield intrauterine device (IUD) (A. H. Robbins, Inc., Richmond, Virginia) that had remained asymptomatic for over 30 years is unusual. Case reports and patient series suggest that intraomental IUDs remain asymptomatic for long periods of time and are usually not associated with chronic pelvic pain.

CASE

A 49-year-old woman with an unrecollected history of Dalkon Shield placement 30 years earlier was evaluated after 6 months of pelvic pain. A negative workup and failure of conservative management prompted an abdominal hysterectomy with bilateral salpingooophorectomy, which failed to relieve the symptoms. Revaluation identified a mobile, intraabdominal Dalkon Shield. Real-time x-ray fluoroscopy and reverse Trendelenburg positioning were used to laparoscopically retrieve the IUD from the patient's benign-appearing omentum. The pelvic pain remained resolved for over 1 year after removal of the IUD.

CONCLUSION

An intraomental IUD that remained asymptomatic for 30 years was the most likely source of chronic pelvic pain in this perimenopausal patient. Increased intraabdominal fat deposition associated with the perimenopause may have contributed to this patient's change in clinical status.