A 48-year-old woman underwent a colonoscopy at our hospital for routine screening.
During the procedure, a suspicious fistula was identified in the descending colon
([Fig. 1]), with a brown metallic foreign body visible at the fistula opening as the endoscope
approached ([Fig. 2]). We grasped the exposed end of the foreign body with biopsy forceps and slowly
pulled it into the intestinal lumen with great caution ([Video 1]). Finally, the foreign body was successfully removed without any active bleeding
and it was confirmed to be an intrauterine device (IUD) ([Fig. 3]).
Fig. 1 An unusual mucosal elevation was found in the descending colon.
Fig. 2 A brown metallic foreign body was visible at the suspicious fistula opening when the
endoscope approached more closely.
The process of endoscopic removal of an intrauterine device transmigrating to the
colonic wall.Video 1
Fig. 3 The foreign body was confirmed to be an intrauterine device after endoscopic removal.
Following the removal of the IUD, we reinserted the scope and confirmed that the fistula
had
closed, obviating the need for additional closure procedures. Further investigation
into the
patientʼs medical history revealed that she had undergone IUD placement at the age
of 38. Apart
from experiencing amenorrhea 3 months prior, she denied any other symptoms.
After the removal procedure, the patient did not report any abdominal pain or fever,
and no additional treatment was deemed necessary. She was monitored in the hospital
for 3 hours until an abdominal computed tomography scan confirmed the absence of perforation.
During the 1-year follow-up period, no adverse events occurred.
The transmigration of an IUD to the colonic wall is an exceptionally rare complication,
with the sigmoid colon being the most commonly observed migrating location. Surgical
intervention is typically necessary in the majority of reported cases [1]
[2]. To the best of our knowledge, this is the first time the migrated IUD was successfully
extracted solely using biopsy forceps without the need for additional measures. Endoscopic
treatment is strongly recommended for patients with IUD transmigration to the colonic
wall as long as there is no evidence of free perforation or associated complications.
Endoscopy_UCTN_Code_CCL_1AD_2AH
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
