Fluoroscopy-Guided Localization and Retrieval of a Migrated Extrapelvic Intrauterine Device: A Case Report.

BACKGROUND: Intrauterine devices (IUDs) are widely used as a highly effective method of contraception. Although rare, uterine perforation is a serious complication, occurring in approximately 1 per 1000 insertions. This case underscores the value of laparoscopy in enabling accurate diagnosis and immediate removal of an occult extrauterine IUD migration. In addition, fluoroscopy guidance improves localization accuracy, facilitates precise retrieval, and may help prevent laparotomy. CASE PRESENTATION: This case presents a 25-year-old woman presented with progressive abdominal pain 1 year after IUD insertion. Physical examination revealed no involuntary guarding and the IUD strings were not visible. Transvaginal ultrasonography showed no evidence of a myometrial defect. An abdominal x-ray with uterine marker demonstrated extrapelvic migration of the IUD. The patient subsequently underwent fluoroscopy-assisted laparoscopic retrieval. Intraoperative findings revealed a uterine scar and dense adhesions between the IUD and the omentum. CONCLUSION: Early clinical suspicion and a structured imaging approach are essential for the diagnosis of extrauterine IUD migration. When pelvic ultrasonography is inconclusive, abdominal radiography with uterine markers can improve localization. Fluoroscopic guidance improves intraoperative localization and facilitates safe minimally invasive retrieval of extrapelvic IUD migration while minimizing surgical morbidity.