Fishing for a Lost Fragment

INTRODUCTION: Fragmented or broken IUDs can pose various health risks. If an IUD fragment is suspected to remain within the uterus, a hysteroscopy should be performed in order to thoroughly evaluate and remove the fragmented IUD. OBJECTIVE: To remove a fragment of a Paragard IUD embedded deep within the cervical wall using an operative hysteroscopy approach. METHODS: Study subject: The patient was a 28-year-old, premenopausal female. She had a Paragard IUD inserted 10 years ago for contraception. Initial Examination: During an in-office IUD removal, the strings were visible and the patient’s physician was able to remove the IUD with minimal resistance. However, upon inspection, it was revealed that the right arm of the IUD was missing. Procedure: An office hysteroscopy was performed, and it was suspected that the fragmented Paragard IUD was remaining in the right upper aspect of the endocervix. The patient was uncomfortable during the office hysteroscopy and thus opted for an operative hysteroscopy under general anesthesia for a thorough and comfortable removal of the IUD fragment. Due to the angle of the embedded IUD arm and the narrow endocervical canal, careful maneuvering of the fragment may be required to dislodge it (rather than pulling on it) for extraction. A hysteroscopic tissue shaver device may be required to shave off superficial myometrial/endocervical tissue to better visualize the fragment and aid in its safe removal. RESULTS: The fragmented Paragard IUD was successfully located and removed from the endocervical wall using an advanced hysteroscopic device. After extraction, the retrieved piece was carefully examined and confirmed to complete the entire IUD, ensuring that the removal was thorough and no fragments remained inside the patient. CONCLUSIONS: Operative hysteroscopy is an effective and efficient technique for removal of a deeply embedded IUD fragment. This procedure could be performed in the office; however, it is ideally performed under appropriate sedation, as the length and complexity of the procedure can vary, ensuring a more comfortable and effective removal.