INTRAUTERINE CONTRACEPTIVE DEVICE AS THE CAUSE OF PERFORATION OF THE BLADDER AND SMALL INTESTINE 17 YEARS AFTER IMPLANTATION

Background. The placement of intrauterine contraceptive devices rarely gives rise to complications.  However, a failure to observe the procedure technique, lack of control, untimely diagnosis of possible device migration can create life-threatening conditions, including the long-term period  after the manipulation.

The aim. To report the case of fistulas of bladder and small intestine caused by perforation with intrauterine contraceptive device placed 17 years ago, and to discuss management tactics.

Case presentation. A 39-year-old woman presented with an external purulent fistula after opening an abdominal abscess caused by dislocation of the intrauterine device 17 years after its placement. The intrauterine device produced pressure ulcers to the cervical wall and to the neck of the bladder, then migrated to the pelvis, where fixed the ileum to the bladder wall with the subsequent abscess formation. After opening the abscess, a purulent fistula of the abdominal wall formed. Multispiral computed tomography detected foreign body. It caused perforation of the ileum wall, abscess development, and formation of a tubular intestinal fistula. The contraceptive device was removed, the ileum was resected and the defect in the bladder wall was sutured.

Conclusion. Dislocation of the intrauterine device into the bladder with its chronic inflammation over the period of 13 years resulted in the development of bladder and small intestine fistulas, abdominal abscess, which required surgical intervention with extensible approach. Awareness of patients and doctors about possible complications of this type of contraception allows them to prevent and timely diagnose hazard aftereffects.  

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