EP26.07: Fluoroscopic‐guided laparoscopic retrieval after uterine perforation and migration of Mirena coil

Intrauterine devices like Mirena and Copper IUCDs are pivotal for women's reproductive health, providing contraception and Mx of menorrhagia. The UK women's health organisation also emphasises the role of IUS insertion in community health care for addressing Long time Mx of menorrhagia, dysmenorrhea, and contraception. A rare but serious complication of IUS insertion is uterine wall perforation and device migration into the peritoneal cavity, incidence of 0.9/1000. This can manifest immediately or later, with the disappearance of the attaching thread. Migration of the coil into neighbouring organs poses risks of injury or attachment to abdominal tissues or organs. Notably, a migrated Mirena coil can result in significantly higher plasma levels of levonorgestrel (10x more than intrauterine levels). Retrieving a displaced IUD in morbidly obese individuals, poses a challenge. We present the case of a 50-year-old woman, BMI >50, experienced lower abdominal pain 10 days post-insertion of IUS, her 3rd over 15 years for contraception and menorrhagia. Despite no abnormal symptoms, the IUS thread was not visible on PV. Imaging revealed a dislodged IUD in the upper abdomen, between the hepatic flexure and jejunal loops. At diagnostic laparoscopy, the Mirena coil was not immediately visualised. However, combining continuous fluoroscopy with laparoscopy enabled successful retrieval buried beneath the omentum and spleen. This case highlights the effectiveness of continuous fluoroscopic imaging and laparoscopy for retrieving migrating lost IUS. This combined approach is recognised in other surgical specialties for foreign body retrieval, few cases reported in gynecology. Such techniques offer faster and precise localisation, reducing operation time involving migrated IUS. Immediate removal from the peritoneal cavity is crucial to prevent long-term complications as higher-than-expected levonorgestrel exposure and intraperitoneal adhesions.