Rasyid Nur, Nainggolan Hoshea Jefferson, Jonardi Prinnisa Almanda, Raharja Putu Angga Risky, Wiweko Budi, Atmoko Widi, Birowo Ponco
Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia.
Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia.
Int J Surg Case Rep. 2021 May;82:105850. doi: 10.1016/j.ijscr.2021.105850. Epub 2021 Apr 1.
Spontaneous migration of a contraceptive intrauterine device (IUD) to the bladder is very rare. It usually takes years for the IUD to migrate completely from the uterine cavity to the bladder. We report a case of early-onset complete spontaneous migration of contraceptive IUD to the bladder in a post C-section patient.
A 30-year-old woman presented with suprapubic pain and dysuria three weeks prior to hospitalization. She had C-section three months prior and underwent copper IUD insertion two months after the surgery. One week after IUD insertion, radiography showed that the IUD remained in the uterus, but the patient felt suprapubic pain and dysuria. Computed tomography (CT) three weeks after IUD insertions showed IUD migration to the bladder with its tips embedded in the uterine wall. Cystoscopy was performed one week later and the IUD was completely inside the bladder. By then, the IUD was removed completely via forceps with no complication.
The exact pathophysiology of spontaneous IUD migration is unknown, but migration always starts with uterine perforation. In our case, uterine perforation was probably caused by immediate traumatic perforation. CT is the preferred radiological examination. IUD removal was performed one month after IUD insertion showing complete migration of the IUD, though CT one week prior suggested that the tips of the IUD remained embedded.
In cases of early-onset complete spontaneous migration of contraceptive IUD to the bladder, CT is the preferred radiological examination, and delaying removal procedure may be beneficial.
避孕宫内节育器（IUD）自发迁移至膀胱极为罕见。IUD通常需要数年时间才能从子宫腔完全迁移至膀胱。我们报告一例剖宫产术后患者中避孕IUD早期完全自发迁移至膀胱的病例。
一名30岁女性在住院前三周出现耻骨上疼痛和排尿困难。她三个月前接受了剖宫产手术，并在术后两个月放置了铜IUD。放置IUD一周后，X线检查显示IUD仍在子宫内，但患者感到耻骨上疼痛和排尿困难。放置IUD三周后进行的计算机断层扫描（CT）显示IUD迁移至膀胱，其尖端嵌入子宫壁。一周后进行了膀胱镜检查，发现IUD完全位于膀胱内。随后通过钳子将IUD完全取出，未出现并发症。
IUD自发迁移的确切病理生理机制尚不清楚，但迁移总是始于子宫穿孔。在我们的病例中，子宫穿孔可能是由即刻创伤性穿孔引起的。CT是首选的影像学检查。放置IUD一个月后进行IUD取出，显示IUD完全迁移，尽管一周前的CT显示IUD尖端仍嵌入。
在避孕IUD早期完全自发迁移至膀胱的病例中，CT是首选的影像学检查，延迟取出手术可能有益。
