Bladder Migration of an Intrauterine Device: Management Through Minimally Invasive Surgery

Migración vesical de dispositivo intrauterino: resolución por cirugía mínimamente invasiva

Abstract

Uterine perforation associated with an intrauterine device (IUD) is a rare complication that can cause extrauterine migration and compromise adjacent organs, such as the urinary bladder. We present the case of a 40-year-old patient with a history of two cesarean sections, who had a copper IUD inserted 1 year and 7 months prior. Ten months after insertion, she experienced a pregnancy that resulted in a missed miscarriage, with the device no longer present in the uterine cavity. Imaging studies allowed the IUD to be located in the pelvic cavity, in close proximity to the bladder. The patient reported mild pelvic pain, so a diagnostic and therapeutic laparoscopy was performed. The device was identified in the vesicouterine space, adhered to the bladder fundus. Cold dissection was performed, achieving complete removal of the device. The postoperative course was favorable. Uterine perforation can occur immediately during insertion or later due to progressive erosion. Factors such as the postpartum period, breastfeeding, insertion technique, and operator experience influence its occurrence. Although bladder perforation is infrequent, it is clinically relevant due to the potential associated complications. Laparoscopy is the preferred approach for its management. Early suspicion and the use of imaging techniques are essential when sutures are absent or when there is a pregnancy with an IUD, allowing for safe and effective resolution even in atypical locations. Keywords: Uterine Perforation; Laparoscopy; Urinary Bladder; Intrauterine Devices (Source: MeSH, NLM).