Uterine Perforation With Extrauterine Intrauterine Device (IUD) Migration Following Blunt Abdominal Trauma: A Case...

Intrauterine devices (IUDs) are widely used long-acting reversible contraceptives with a favorable safety profile. However, uterine perforation is a rare complication that may result in extrauterine migration of the IUD and may also involve adjacent pelvic or abdominal structures, and is often an incidental finding during imaging performed for unrelated indications. We present the case of a 32-year-old female with a copper IUD placed approximately seven years prior without gynecologic follow-up who presented to the emergency department following a motor vehicle collision with abdominal pain. The patient was hemodynamically stable. Abdominal examination demonstrated diffuse tenderness to palpation with involuntary guarding. Computed tomography of the abdomen and pelvis demonstrated uterine fundal perforation with extrauterine migration of the IUD abutting and possibly penetrating the distal sigmoid colon without other imaging findings. Repeat imaging at a tertiary trauma center confirmed stable extrauterine IUD positioning without evidence of interval change. Given clinical stability and absence of overt visceral perforation, multidisciplinary evaluation favored conservative inpatient observation with close outpatient follow-up for definitive removal. The absence of prior gynecologic symptoms supports blunt trauma as the precipitating mechanism of uterine perforation. Perforated IUDs do not always cause pneumoperitoneum or hemoperitoneum. Clinicians evaluating patients with indwelling IUDs after blunt pelvic trauma should maintain a high index of suspicion for acute perforation and ensure systematic assessment of device position on cross-sectional imaging.