Delayed intravesical migration of an intrauterine device (IUD) and subsequent successful pregnancy: a case report of diagnostic and surgical challenges

Abstract

Intrauterine devices (IUDs) are among the most effective and widely utilized methods of reversible contraception. Although uterine perforation and extrauterine migration are uncommon, delayed diagnosis may lead to serious complications involving adjacent pelvic organs, including the urinary bladder. A 32-year-old multiparous woman (G2P2) presented with a chronic progressive hypogastric pain, dysuria, urinary frequency, and worsening dysmenorrhea, which had intensified during the last two months. She had undergone a Copper T380A IUD insertion 14 years ago and subsequently experienced a successful pregnancy and vaginal delivery three years later. Physical examination demonstrated localized hypogastric tenderness with a positive Carnett sign. Laboratory investigations revealed leukocytosis, elevated CRP and ESR, and microscopic hematuria. Imaging with transvaginal ultrasonography, magnetic resonance imaging, and computed tomography demonstrated migration of the IUD through the bladder wall with associated abscess formation. Cystoscopy showed only mild mucosal inflammatory changes without intravesical device exposure. Due to extensive fibrosis and bladder wall involvement, open surgical exploration with partial cystectomy was performed, resulting in complete removal of the device. Histopathological examination confirmed a foreign body granulomatous reaction with dystrophic calcification and chronic lymphocytic infiltration. Delayed IUD migration may remain asymptomatic for years and should be considered in patients presenting with unexplained pelvic pain or urinary symptoms, even long after insertion. Multimodal imaging facilitates diagnosis and surgical planning, while individualized surgical management is required for extensive bladder involvement.