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A 36-year-old grand multiparous midwife presented to the gynaecological unit of the University of Uyo Teaching Hospital with the string of an intrauterine contraceptive device (IUCD) protruding from her anus. She had had a copper IUCD inserted at a health centre 8 years earlier. However, 4 months later she noticed that she no longer felt its strings and had another IUCD inserted in the same facility when the first device was not located. Four months prior to presentation, she presented to a private clinic when she no longer felt the strings of the second IUCD. The device in the uterus was removed in the private clinic and she was referred to the teaching hospital. At the teaching hospital rectal examination and plain x-ray revealed the presence of a device. Under general anaesthesia, the device was successfully removed in theatre through the rectum with no postoperative complications.
Perforation of the rectum with the strings of an IUCD protruding from the anus is very rare and to the knowledge of the authors has not previously been reported in Nigeria.1
In addition, this case highlights certain pitfalls in the management of the patient.
The patient presented with the strings of an IUCD protruding from her anus (figure 1). Her medical history was not significant. She was a divorcee and a midwife who did not smoke or drink alcohol.
The IUCD was removed via the rectum (figure 3).
Good outcome with no complications after removal.
Uterine perforation is a minor but serious complication associated with the use of an IUCD.2 In about 80% of perforations, the devices are located freely in the intraperitoneal space.2 3 Rectal perforation with strings protruding from the anus is exceptionally rare with very few cases reported in the literature.
Competing interests None.
Patient consent Obtained.