44 years of neglecting an intrauterine contraceptive device.

Ho Chi Minh City – After giving birth to five children, Mrs. Tuat had an IUD inserted. 44 years later, the IUD pierced her uterine muscle, posing a risk of infection.

Mrs. Pham Thi Tuat, now 80 years old, recently experienced painful urination and abnormal vaginal bleeding. An ultrasound at Tam Anh General Hospital in Ho Chi Minh City revealed that her intrauterine device (IUD) had penetrated the uterine muscle.

On August 18th, Dr. Lam Hoang Duy, a specialist at the Obstetrics and Gynecology Center, stated that Mrs. Tuat's intrauterine device (IUD) was made of soft plastic and had a pyramidal structure like a Christmas tree. This type of IUD is quite old and is no longer in use.

Ms. Tuat said she had an IUD inserted after giving birth to five children but then forgot about it and didn't go to the hospital to have it removed.

According to Dr. Duy, an IUD left in the uterus for too long is like a foreign object. An expired IUD can easily become dislodged, fractured, penetrate the abdominal cavity, attach to nearby organs, potentially leading to uterine perforation, peritonitis, or hemorrhage. In rare cases, the IUD may migrate into the pelvic organs.

Like the elderly woman mentioned above, her long-term IUD had become adherent to the uterine wall, and since she had long since gone through menopause and her uterus had shrunk, surgery was necessary to remove the IUD. However, the patient was elderly, had high blood pressure and diabetes, and feared complications during the IUD removal surgery.

The doctors administered anesthesia and removed the IUD vaginally, along with a uterine biopsy for cancer screening. Normally, the procedure for removing an IUD on schedule is simple and only takes 10 minutes. However, due to Mrs. Tuat's small uterus, removing the IUD was more difficult and carried more risks, such as uterine perforation. An ultrasound doctor in the operating room assisted the obstetrician/gynecologist in locating and safely removing the IUD. One day later, she was healthy and discharged from the hospital.

The doctor checks on Mrs. Tuat's health after she had her IUD removed. Photo: Tue Diem — The doctor checks on Mrs. Tuat's health after she had her IUD removed. Photo: *Tue Diem*

Mrs. Tuat is the oldest patient who forgot to remove her IUD for the longest time that Dr. Duy has ever encountered. Tam Anh Hospital has received many cases of IUDs that expired 20-30 years ago but were not removed, leading to complications such as uterine perforation, bowel perforation, and bladder stones.

According to Dr. Duy, complications after IUD insertion are rare but can be serious due to uterine perforation (at a rate of 1.3-1.6 cases per 1,000 insertions). The IUD can also protrude through the uterus and fall into the abdominal cavity, bladder, colon, small intestine, etc., causing injuries, infections, peritonitis, or internal bleeding, and even death.

Many cases of misplaced IUDs are asymptomatic. When symptoms do occur, they can vary, including mild abdominal pain, vaginal bleeding, infertility, fever, diarrhea, or gastrointestinal bleeding. Some individuals may experience bowel obstruction or necrosis. Dr. Duy stated that exploratory laparoscopy is the first-line treatment, with a high success rate, potentially reaching 100%.

Both intrauterine devices (IUDs) and contraceptive implants have an expiration date. IUDs last 5-10 years, while implants last 3-5 years. Women who have had a contraceptive implant inserted should see a doctor immediately if they can't feel the implant in their upper arm.

Tue Diem

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