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

Objectives: 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.

Case: 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.

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