Silent Migration of an Intrauterine Device into the Peritoneum: A Case Report

Uterine perforation is an uncommon but potentially adverse outcome of intrauterine device (IUD) placement. It often occurs around the time of insertion and may go unnoticed, though delayed perforation can also present months or years later. Diagnosis is typically suspected when IUD strings are not visualized on vaginal examination and confirmed by imaging demonstrating displacement, perforation, or migration. Definitive management requires device removal. We report the case of a 34-year-old woman with silent migration of a levonorgestrel-releasing IUD into the peritoneal cavity. IUD displacement was incidentally noted during a routine Papanicolaou (Pap) test six months after insertion when the strings were not visualized. A pelvic ultrasound done at that time reported an IUD embedded in the uterine wall without serosal perforation. Unfortunately, delayed follow-up, partly due to financial limitations, caused further migration. A repeat ultrasound and pelvic X-ray performed 11 months after insertion confirmed intraperitoneal displacement. She remained asymptomatic throughout this period. The IUD was ultimately retrieved by laparotomy, where it was found in the peritoneum, loosely adherent to the greater omentum. This case underscores the potential for asymptomatic migration of a levonorgestrel-releasing IUD, the risks associated with delayed intervention, and the influence of financial and resource limitations on timely diagnosis and optimal management.