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.