Uterine perforation and migration of an intrauterine contraceptive device in a 24-year-old patient seeking care for abdominal pain

ObjectiveThe purpose of this case report is to describe the case of a 24-year-old woman complaining of diffuse abdominal pain following insertion of an intrauterine contraceptive device (IUC).MethodsA 24-year-old woman, 8 weeks postpartum, sought chiropractic care for intermittent stabbing pain in her left upper quadrant that had been present for a week. She returned 1 week later with no resolution of her complaint. She then recalled that, at her 6-week gynecological examination, she had undergone insertion of an IUC and that the abdominal pain had begun a week later. She was advised to return to her gynecologist. Subsequent evaluation by the gynecologist revealed that the IUC had perforated her uterus and had migrated to the upper left quadrant of her abdomen, where it was found anterior to the L1-2 vertebral bodies, lying in contact with the anterior surface of the abdominal aorta. To our knowledge, this is the only report of this type of presentation in a chiropractic office.ResultsThe initial intervention with this patient included chiropractic adjustment and myofascial release. At her subsequent visit, with no resolution of her complaint, she was referred back to her gynecologist for additional evaluation. Because the IUC had perforated her uterus, she underwent emergency laparoscopic surgery. The surgery was successful, and she recovered fully.ConclusionChiropractic physicians should consider uterine perforation by IUC in the differential diagnosis of a female patient of childbearing age seeking care for abdominal pain.