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Abstract

We present a case report of a 36-year-old woman with an accidental finding of two intrauterine contraceptive devices (IUCD); one being present inside the uterine cavity and other one located in the upper abdomen. She presented to the emergency room with missed periods, abdominal pain, nausea, and vomiting. On evaluation her serum beta HCG test was positive. Given that she had a history of postpartum IUCD (Multiload 375) insertion for contraception, possibility of ectopic pregnancy was suspected.  Nevertheless, her transvaginal pelvic ultrasound showed an early intrauterine pregnancy without an IUCD. As the IUCD was placed postpartum, it was considered that it had expelled leading the patient exposed to the possibility of conception.  Furthermore, radiologic imaging was not performed as she was considering continuation of pregnancy. She subsequently chose to have termination of this pregnancy with her obstetrician at another hospital, where after termination of pregnancy a second intrauterine contraceptive device was inserted in the uterine cavity. After 9 months of her initial presentation, she presented to the hospital with history of lower abdominal pain along with a plain pelvic radiograph showing two IUCDs. A limited CT-Scan pelvis was performed which showed one IUCD correctly placed inside the uterine cavity and another IUCD misplaced in the lower abdomen. The misplaced IUCD was successfully removed laparoscopically, which was adherent to the anterior abdominal wall with overlying omentum in the upper abdomen.  She and her husband were later duly counselled about the operative findings, and she was discharged home the same day to be followed in an outpatient clinic.