Figure 1. Copper IUCD surrounded with adhesions stuck to anterior abdominal wall.
Figure 2. Retrieving the copper IUCD after adhesiolysis.
In most of the cases, uterine perforations are asymptomatic and hence are not recognized at the time of insertion. Non operative management of a migrating IUD has been recommended in the past because of the morbidity associated with its removal.  But, a migrated IUCD can lead to pain, fibrosis, and adhesion formation and sometimes, may even result in penetration into adjacent organs like the urinary bladder, sigmoid colon, appendix, and small bowel. Perforation into the bowel is also a documented complication and can result in abscess formation, ischemia, or volvulus. Therefore, it has been advised that surgical exploration and IUD retrieval should be the primary therapeutic approach for patients with a misplaced IUCD. 
Literature suggests that Uterine perforation almost always occurs during insertion of IUCD. Its incidence is related to the timing of insertion, type of the device, the anatomy of the uterus and cervix, the skill of the person performing the insertion and other factors include soft uterine wall, a previous recent pregnancy or an abortion and the presence of a previous uterine scar, if any. Secondary perforation of the uterus can occur by slow migration of the IUCD directly through the wall of the uterus, augmented by contractions of the uterus and urinary bladder. Rarely, a migrated IUCD can be found in lower anterior abdominal wall. The colon and the bladder are the adjacent structures of the uterus and a migrated IUCD is usually lodged in these structures. But as seen in this case, it is rare for an IUCD to avoid these adjacent structures and migrate into the lower anterior abdominal wall. Thus in our case, the bladder and the bowel were spared of any perforations, but adhesions were present engulfing the copper IUCD and attached to the anterior abdominal wall .A regular follow up for detection of misplaced IUCD is stressed as it can have an unusual presentation. Prevention is the best remedy; hence correct insertion by skilled surgeon is the required. Regular follow up should be made mandatory. If in doubt ultrasound or pelvic radiograph should be done. And an asymptomatic misplaced IUCD should be managed vigorously as delay can increase intraabdominal adhesions and make it difficult for its retrieval.
- Rajeshwari NV, Hasalkar JB. IUD retention in shimoga district of Karnataka. Journal of family welfare. 1996;42(1):44-9.
- Kriplani Alka, Garg Pradeep, Sharma Meenakshi, Agarwal Nutan. Laparoscopic removal of extrauterine IUCD using fluoroscopy guidance: a case report. Journal of Gynaecologic Surgery. 2005;21(1): 29–30.
- Markovitch O, Klein Z, Gidoni Y, et al. Extrauterine mislocated IUD. Is surgical removal mandatory? J Fam Plann Reprod Health Care. Contraception. 2002; 66(2): 105-8.
- Mederos R, Humaran L, Minervini D, et al. Surgical removal of an intrauterine device perforating the sigmoid colon: a case report. Int J Surg. 2008 Dec; 6(6):e60-2.
- Boyon C, Giraudet G, Guerin Du Masgenet B, Lucot JP, Goeusse P, Vinatier D. Diagnosis and management of uterine perforations after intrauterine device insertion: A report of 11 cases. Gynecol Obstet Fertil. 2013 May;41(5):314-21
- Singh Iqbal. Intravesical Cu-T migration: an atypical and infrequent cause of vesical calculus. Int Urol Nephrol. 2007;39: 457-59.
- B. Mülayim, S. Mülayim, N. Y. Celik, “A lost intrauterine device. Guess where we found it and how it happened?” Eur J Contracept Reprod Health Care. 2006 Mar;11(1):47-9.
Shah NH, Paranjpe SH, Shah VN. Laparoscopic Retrieval Of Missing Copper Intrauterine Device Stuck To Anterior Abdominal Wall Presenting Along With 8 Weeks Of Pregnancy. JPGO 2015. Volume 3 No. 1. Available from: http://www.jpgo.org/2016/01/laparoscopic-retrieval-of-missing.html