A woman, fitted with a Mirena intrauterine system (IUS), presented with a positive pregnancy test and a 5-day history of per vaginam bleeding and left iliac fossa pain. Beta-hCG level was raised at 1815 IU/l and a pelvic ultrasound scan showed a normal empty uterus. An abdominal x-ray showed that the IUS was in the left hypochondrium. At laparoscopy, an ectopic pregnancy was discovered in the left fallopian tube. The IUS was removed laparoscopically. This is likely to be the first reported case of a simultaneous ectopic pregnancy and an extrauterine system. It is not clear whether removal of the Mirena IUS was necessary.
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