Association between timing of surgical retrieval and organ involvement after uterine perforation by an intrauterine device.

OBJECTIVE: To evaluate the association between the interval from intrauterine device (IUD) placement to surgical retrieval and intraoperative findings in women with uterine perforation and intraperitoneal IUD location. STUDY DESIGN: A retrospective cohort study at a single tertiary, university-affiliated referral center, including women who underwent laparoscopic retrieval of an intraperitoneal IUD following uterine perforation between 2014 and 2026. Clinical and operative data were systematically collected through detailed review of medical records and operative reports. The primary outcome was intraoperative anatomical localization, classified as free pelvic, omental/mesenteric, or visceral involvement, and its association with the interval from IUD placement to surgical retrieval was evaluated. Retrieval timing was analyzed both as a continuous variable and using a predefined 4-week threshold. Multivariable logistic regression was performed to identify factors independently associated with organ involvement. RESULTS: A total of 46 patients were included. Intraoperative localization was free pelvic in 22 patients (47.8 %), omental/mesenteric in 20 (43.5 %), and visceral in 4 (8.7 %). All four visceral cases involved the bowel, with one also involving the urinary bladder. Retrieval beyond 4 weeks occurred in 31.8 % of patients with free pelvic localization, 90.0 % with omental/mesenteric involvement, and 100 % with visceral involvement (p < 0.001). In multivariable analysis, retrieval beyond 4 weeks remained independently associated with tissue-associated localization after adjustment for IUD type (adjusted OR 21.00, 95 % CI 3.66-120.53; p < 0.001). Laparoscopic retrieval was completed in 45 of 46 patients (97.8 %), with one conversion to laparotomy. CONCLUSION: In patients with intraperitoneal IUD following uterine perforation, later surgical retrieval was associated with a higher likelihood of omental, mesenteric, or visceral involvement. The interval from placement to surgery may provide useful information during preoperative evaluation, surgical planning, and patient counseling.