A 60-year-old Somalian woman presented to the emergency department with pain in the upper abdomen. Her medical history was notable for the placement of an intrauterine device (IUD) while she was living in Somalia. After the placement of the IUD, she continued to have children.
Radiography of the abdomen showed an IUD in the left upper quadrant. Further evaluation revealed that she had cholecystitis. The IUD was easily removed during the laparoscopic cholecystectomy.
The incidence of uterine perforation and migration of IUDs is approximately 1 to 2 cases per 1000 insertions. During puerperium, when the uterus is small and thin, there is an increased risk of perforation. Perforation is often silent, and the IUD is detected only after injury to other organs or incidentally by imaging.