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A Woman With an Intrauterine and an Extrauterine Intrauterine Device

      A 44-year-old woman with a history of hypertension and partial gastrectomy presented to the emergency department with low thoracic back pain of 2 days' duration without red flag symptoms. The physical examination was significant for point tenderness to palpation in the lower thoracic spine without overlying skin changes or neurologic symptoms. Considering her large body habitus and history of gastrectomy, a thoracic radiograph was obtained to rule out compression fracture due to osteoporosis (Figure 1). No fracture was identified, but a radiopaque object in the left abdomen was identified along with an intrauterine device (IUD) in the pelvis. Further questioning revealed that the patient's first IUD was placed 3 years after her first pregnancy, and the patient was surprised to become pregnant again later that same year. She denied retrieval or displacement of the first IUD, and she went on to have a normal vaginal delivery with a second IUD placed after delivery of her second child. No investigation or studies were undertaken to search for the first IUD. A computed tomography scan revealed a migrated IUD in the left abdomen as well as an intrauterine IUD (Figure 2). After consultation with the department of obstetrics and gynecology, the patient was scheduled for elective retrieval of the extrauterine IUD.
      Figure thumbnail gr1
      Figure 1Lumbar radiograph with pelvic intrauterine device (block arrow) and extrapelvic intrauterine device (arrow).
      Figure thumbnail gr2
      Figure 2Computed tomography scan of the abdomen and pelvis. Note the extrapelvic intrauterine device (arrow).
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