CASE REPORT
A 22-year-old para 1, regularly menstruating female presented to the emergency of Jalalabad Ragib Rabeya Medical College, Bangladesh on June 15, 2021, with acute right lower abdominal pain, fever, and leukocytosis for 3 days. With the suspicion of acute appendicitis, diagnostic laparoscopy was done, however, a dislocated Cu IUCD leading to an abdominal abscess was discovered. The lady had initially not given the history of Copper IUCD insertion as she believed it had not been placed properly. But on further questioning post-operatively it was discovered that she had a copper intrauterine contraceptive device (IUCD) inserted 2 years ago after the delivery of her first child. Post insertion of the device, the patient did not follow up with a gynaecologist. She could not palpate the strings of the device and assumed that insertion of the device was not done properly. She didn’t go to follow up due to personal reasons even after failing to palpate the string of IUCD. Moreover, the patient conceived 1 month after the insertion of the device, further confirming her belief that the device wasn’t actually placed inside her as it should have been. The patient started having spontaneous vaginal bleeding at 8 weeks of gestation which led to spontaneous abortion. After the expulsion of the product of conception, she went to a local health clinic and ultrasound showed complete expulsion of the product of conception. At the clinic she did not give a history of the insertion of Copper IUCD and the ultrasound scan at that time showed an empty uterine cavity with a small blood clot at the cervix and bilateral ovaries were normal looking. There was no mention of Cu IUCD in the scan. After a few weeks of abortion, she started having nonspecific dull abdominal pain for which she got treated conservatively with analgesics in the local health clinic.
On June 15, 2021, the patient presented to the emergency of our hospital with acute right lower abdominal pain for 3 days as aforementioned. At the time of examination, her temperature was 101 degrees Fahrenheit, BP- 110/50 mm of Hg, RR- 15 breath/min, Pulse- 98/min.  Abdominal examination revealed tenderness in the right iliac fossa, guarding, rigidity, and rebound tenderness. Ultrasonography of the abdomen revealed mixed echoic lesion measuring about 3.5× 1.5 cm and minimal collection in the right iliac fossa region (Figure 1). Blood investigations revealed leukocytosis with 88% neutrophilia. Other blood investigations and biochemistry were within normal limits. With the provisional diagnosis of acute appendicitis, laparoscopy was planned. Laparoscopy revealed a normal appendix but found an abscess approximately 4 x 3 cm in the parietal wall of the abdomen near the right iliac fossa due to a copper IUCD. The right fallopian tube was found adherent with the abscess cavity. Adhesiolysis was done and the abscess was drained (Figure 2). The device was removed from the peritoneal cavity, and shown to the patient after she recovered from surgery (Figure 3). The drain tube was kept in situ post-operatively. The postoperative recovery was uneventful and the patient was discharged on the 4th postoperative day with oral antibiotics.