Incidental discovery of two levonorgestrel-releasing intrauterine systems misplaced in the peritoneal cavity

To present a rare case of the incidental discovery of two misplaced intrauterine devices in the same patient, and to discuss risk factors for uterine perforation and appropriate management.

A 37-year-old woman complaining of chronic lower back pain presented with an X-ray of her abdomen showing two misplaced LNG-IUSs in the peritoneal cavity. More than two years before the patient had submitted within two months to two successive attempts at insertion of a Mirena® IUS. The threads of the first IUS were not seen at the follow-up visit and the IUS was not detected on ultrasound either. As it was assumed to have been expelled, insertion of a second IUS of the same type was attempted. Again, the threads were not seen at the control visit. This time, no further action was undertaken.

Radiography is helpful in confirming migration of an intrauterine contraceptive. Removal of the latter is recommended, due to the potential for serious complications.