Song Hong-Xia, Xie Tian-Hao, Fu Yan, Jin Xiao-Shi, Wang Qiang, Niu Zheng, Sun Qian, An Xiu-Hua
Department of General Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei, China.
Basic Research Key Laboratory of General Surgery for Digital Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei, China.
Front Med (Lausanne). 2025 Jul 7;12:1613116. doi: 10.3389/fmed.2025.1613116. eCollection 2025.
Intrauterine devices (IUDs) are widely used but carry rare risks of migration and subsequent complications, such as bowel obstruction. This case highlights the life-threatening potential of chronic IUD migration decades after insertion, emphasizing the need for heightened clinical vigilance and long-term surveillance. A 57-year-old female patient presented to the hospital with a 2-day history of abdominal pain, accompanied by the cessation of flatus and defecation. She had one pregnancy and one vaginal delivery 31 years ago, followed by the insertion of a ring-shaped IUD 1 year postpartum. However, she had not undergone any follow-up examinations since the IUD placement. Two years prior to admission, she attempted to have the IUD removed, but it was not detected within the uterine cavity. This resulted in the assumption that the device had been spontaneously expelled, and no further investigations were pursued at that time. CT imaging revealed small bowel obstruction and a ring-shaped intra-abdominal foreign body. Emergency laparotomy identified a migrated IUD strangulating 100 cm of necrotic ileum. Upon exploration of the uterus, a fibroid was identified on the posterior wall, but no acute perforations or other pathological changes were noted. Subsequently, the IUD was removed, and bowel resection with anastomosis was performed. Chronic IUD migration may evade detection for decades, culminating in catastrophic bowel obstruction. Clinicians must maintain high suspicion for IUD-related complications in patients with abdominal pain, even years after insertion. Prophylactic removal of misplaced devices and long-term imaging surveillance are critical to prevent morbidity. Early recognition of such rare but severe complications through comprehensive clinical assessment and imaging studies can significantly improve patient outcomes and reduce the risk of life - threatening bowel - related events.
宫内节育器（IUD）被广泛使用，但存在罕见的移位风险及随后的并发症，如肠梗阻。本病例凸显了宫内节育器插入数十年后慢性移位的潜在致命性，强调了提高临床警惕性和进行长期监测的必要性。一名57岁女性患者因腹痛2天入院，伴有停止排气排便。她31年前怀孕一次并经阴道分娩，产后1年放置了环形宫内节育器。然而，自放置宫内节育器后她未进行过任何随访检查。入院前两年，她试图取出宫内节育器，但在宫腔内未检测到。这导致推测该装置已自行排出，当时未进一步追查。CT成像显示小肠梗阻及一枚环形腹腔内异物。急诊剖腹探查发现一枚移位的宫内节育器绞窄100 cm坏死回肠。探查子宫时，在后壁发现一个肌瘤，但未发现急性穿孔或其他病理改变。随后，取出宫内节育器，并进行了肠切除吻合术。宫内节育器慢性移位可能数十年未被发现，最终导致灾难性的肠梗阻。临床医生必须对腹痛患者，即使在宫内节育器插入数年之后，高度怀疑与宫内节育器相关的并发症。预防性取出移位的装置和长期影像学监测对于预防发病至关重要。通过全面的临床评估和影像学研究早期识别此类罕见但严重的并发症，可显著改善患者预后并降低危及生命的肠道相关事件的风险。
