Laparoscopic Management of a Migrated Intrauterine Device Causing a Partial-Thickness Rectal Injury Diagnosed Following Contraceptive Failure: A Case Report

Intrauterine devices (IUDs) are widely used long-acting reversible contraceptives due to their efficacy and safety. Although generally well tolerated, uterine perforation with subsequent migration into adjacent pelvic or abdominal organs is a rare but potentially serious complication. Rectal involvement is exceptionally uncommon and often clinically silent. We report the case of a 32-year-old woman who presented with complete abortion of an unintended pregnancy 18 months after IUD insertion. On physical examination, the IUD strings could not be visualized, and transvaginal ultrasound failed to locate the device within the uterine cavity. An abdominopelvic X-ray identified the IUD within the pelvic cavity. Diagnostic laparoscopy revealed the device embedded in the anterior rectal wall, resulting in a partial-thickness rectal wall injury. The IUD was successfully removed, and the rectal defect was repaired laparoscopically. The patient's postoperative course was uneventful, and she remained asymptomatic at follow-up. This case contributes to the limited literature on rectal wall injury secondary to IUD migration and highlights how such cases may remain undetected without a high index of suspicion and appropriate imaging. Early recognition and timely minimally invasive surgical management are essential to ensure optimal patient outcomes and to prevent serious complications, including abscess formation, fistula development, and bowel injury. This report underscores the importance of considering IUD migration and possible pelvic organ injury in patients presenting with missing strings or unintended pregnancy.