Rectovaginal Fistula on Migration of an Intrauterine Device: A Case Report and Literature Review

Intrauterine devices (IUDs) are effective methods of contraception widely used worldwide because of their efficacy, low cost, and reversibility. Although overall well-tolerated, they may, however, cause uterine perforation, a rare but serious complication that can endanger adjacent abdominal organs. We report the case of a 50-year-old woman who consulted a gastroenterologist three years ago for the detection of blood in her feces on a screening test (Hémoccult°). Colonoscopy and abdominopelvic imaging discovered a displaced IUD embedded in the recto-sigmoidal wall. A wait-and-see approach was proposed at that time because of the absence of symptoms. Three years later, she developed abdominal and pelvic pain. On a second laparoscopic surgery procedure, we removed the IUD. Intraoperatively, a rectovaginal fistula was also discovered and sutured in different anatomical planes. Based on a comprehensive review of the literature, the management of this case is confronted with guidelines available for this rare condition.