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Corresponding Address: Brian S. Shin, md, Department of Emergency Medicine, New York Presbyterian–Brooklyn Methodist Hospital, 506 6th St., Brooklyn, NY 11215
Affiliations
Department of Emergency Medicine, New York Presbyterian–Brooklyn Methodist Hospital, Brooklyn, New York
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 1Lumbar radiograph with pelvic intrauterine device (block arrow) and extrapelvic intrauterine
device (arrow).
Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices.
