Intracavitary Intrauterine Device Encased in Tissue Treated With Office Hysteroscopy: A Case Report

INTRODUCTION: Office hysteroscopy is an established and effective means of removing retained intrauterine devices (IUDs). This is typically indicated in the setting of the IUD embedding into the uterine wall or IUD malpositioning. Hysteroscopic management of retained IUD secondary to encapsulation in tissue within the endometrial cavity is less well described. Surgical tips and tricks from highly experienced office hysteroscopists can be adopted to safely succeed in more difficult cases in the office setting. OBJECTIVE: We present a case of an IUD encased in fibrotic tissue within the uterine cavity and hysteroscopic removal in the office to illustrate a rare IUD complication and means of adapting techniques of office hysteroscopy to effectively manage it. METHODS: A case study with preoperative images, surgical video, and postoperative follow-up with second-look ultrasound is reviewed. Care took place at an outpatient academic clinic of a tertiary care center in the Bronx, New York. The patient was a 55-year-old para 3 postmenopausal person with a history of IUD placed about 20 years prior who reported longstanding history of intermittent pelvic pain. The IUD strings did not pass through the cervix. Saline-infused sonohysterogram demonstrated the IUD encased in an avascular polypoid structure 1.8 cm in largest diameter within the endometrial cavity. Office hysteroscopy was performed with patient in lithotomy position. Follow-up took place in the office 2 weeks later. RESULTS: The copper IUD was successfully removed in its entirety. The encasing tissue was densely adherent to the uterine side wall. The tissue was biopsied, divided from its attachments hysteroscopically, and the patient was prescribed misoprostol for the passage of tissue. At follow-up, patient reported having passed the tissue, which was confirmed by follow-up pelvic ultrasound. Histologic evaluation of the biopsies showed fibrin with calcifications. CONCLUSIONS: This is the first demonstration, to our knowledge, of how to address a rare finding of IUD encased by tissue in the uterine cavity with office hysteroscopy.