Mona Zafar, Badar Murtaza, Saira Saeed.
Displaced Intrauterine Contraceptive devices (Copper – T).
J Coll Physicians Surg Pak Jun ;14(7):427-9.

A young lady of 34 years of age presented with pain in the right lumbar region and right lower abdomen of one year duration. This was associated with dysuria and urinary frequency. She had no history of vaginal discharge, haematuria, menstrual irregularity or fever. About 5 years ago, after the birth of the third child, she decided for contraception and went to a local dispensary, where a lady health visitor (LHV) inserted a copper-T. However, she did not have the next menses-had conceived and delivered a male baby at home by spontaneous vaginal delivery with no intra-partum or post-partum complications. After two months she went again to the local dispensary for copper-T insertion by the LHV. She did not have a follow up visit. Therefore, she had two pregnancies and delivered two healthy babies at home. There were no complications. Her last born baby was one year old and she was having lactational amenorrhea. On examination she had stable vital signs and the abdomen revealed deep tenderness in the right iliac fossa and hypogastrium. On speculum examination the vagina and cervix were normal and no thread was visible in the vagina. Bimanual examination revealed a retroverted, normal sized and mobile uterus. Urethra was normal. Plain X-ray KUB revealed two copper-T devices in the pelvic region. One was surrounded by diffuse radio-opaque shadow suggestive of a stone around the device. An exploratory laparotomy was planned. A white thread was seen coming out of a well defined swelling in the right half of the posterosuperior surface of the urinary bladder. The swelling was firm and indurated. A calculous moulded around the copper-T was found lying free in the urinary bladder. The stone was removed and the indurated area was palpated bimanually. It was opened intraperitoneally and 2-3 ml of thick pus was drained from the subserosal plane. Within the pus another copper-T was seen and its thread was extending into the peritoneal cavity.

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