An asymptomatic postmenopausal uterine perforation with bilateral embedment by a V-shaped intrauterine device: a case report

This case illustrates that postmenopausal IUD retention can culminate in severe, multi-organ-adjacent perforation without symptoms, and that ultrasound may underestimate the extent of extrauterine involvement. In hysteroscopic IUD removal, "extreme traction resistance" should be treated as an intraoperative red-flag prompting immediate cessation and conversion to laparoscopy. A combined hysteroscopic-laparoscopic strategy enables controlled dissection, organ protection, particularly the ureter and tube, and complete retrieval with minimal uterine trauma.