Indian Journal of Science and Technology

Abstract

Background: Reliable, reversible most widely used, contraceptive method worldwide is intrauterine device (IUCD). The association between tubo ovarian abscess formation and the presence of an intrauterine device is well recognized.
Case Report: We report a case of forgotten IUCD for 22 years in 41 years woman with Tubo Ovarian mass. No history suggestive of STD or chronic illness or immunocompromised condition. After first child (22 years ago) she never conceived, had on and off abdominal pain, patient was unaware of IUCD insertion and did not had any gynaec checkup. She was admitted for abdominal pain since 2 days. Abdominal palpation revealed vague tenderness in left iliac region and mass about 8x6 cm size. No guarding or rigidity. Her pelvic examination revealed the IUCD string with mild discharge and IUCD was removed. Bimanual examination revealed marked cervical motion tenderness and left adnexal tender. Tense mass felt per abdomen was felt per vaginum. Rectal examination was normal. USG - Abdomen and Pelvis-complex TO mass left side about 5cmx8cm with minimal fluid on POD. Patient was on IV fluids and parenteral antibiotics. After two days patient developed general peritonitis, hence emergency Laparotomy was done. After informed consent Total abdominal Hysterectomy with omentectomy was done. Histopathology confirmed bilateral tubo ovarian abscess and Omentum - Micro abscess.
Conclusion: Only after concerned IUCD to be introduced and long-term users of IUCDs remain at risk for serious, indolent pelvic infections and hence counseling should be given before insertion and need for follow up should be stressed.

Keywords: Contraceptive Safety, Counseling for IUCD, IUCD Complication, IUCD Procedures, Pelvic Inflammatory Disease, Risk Factors