Rare case report of generalized peritonitis secondary to perforated ileum following retained intrauterine device in a 49-year-old female: Successful Surgical Management at Ambo University College of Health Sciences and referral hospital

Rare case report of generalized peritonitis secondary to perforated ileum following retained intrauterine device in a 49-year-old female: Successful Surgical Management at Ambo University College of Health Sciences and referral hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Rare case report of generalized peritonitis secondary to perforated ileum following retained intrauterine device in a 49-year-old female: Successful Surgical Management at Ambo University College of Health Sciences and referral hospital Iranfachisa Gurmu Amana, Sinbona Ararsa Keneni, Diriba Gebeyehu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8011231/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Generalized peritonitis is a life-threatening condition often caused by gastrointestinal perforation. Intrauterine devices are commonly used contraceptive methods, and complications are rare but can include uterine perforation and migration into adjacent organs. The condition arises from the migration of the Intrauterine devices from the uterus into the abdominal cavity, where it can embed in and perforate the small bowel, leading to a severe peritonitis from spilling intestinal contents. We report a rare case of a 49-year-old female who developed generalized peritonitis secondary to ileal perforation caused by a retained intrauterine device. Early recognition and timely surgical intervention were crucial for a favorable outcome. Figures Figure 1 Figure 2 Introduction Intrauterine devices are widely used for long-term contraception. Uterine perforation is an uncommon but serious complication, with the potential to migrate into the peritoneal cavity or adjacent organs. Gastrointestinal perforation caused by a migrated IUD is extremely rare ( 1 ). Prompt diagnosis and surgical management are essential to reduce morbidity and mortality associated with generalized peritonitis ( 2 ). Case Presentation A 49-year-old female presented with no documented chronic illnesses and a four-day history of generalized abdominal pain that was sudden and included increased abdominal distension, nausea, vomiting, and fever. She has a history of intrauterine device (IUD) insertion 12 years ago. Upon physical examination, she had a fever and her pulse was rapid and weak. Her abdomen was distended and examination yielded generalized tenderness, guarding, and rebound tenderness diagnostic of peritonitis. Other systems were normal. The abdominal X-ray and then subsequent tests were indicative of abuse and later systemic infection due to migration of the foreign body, which was confirmed to be a retained IUD located in the ileum and possible bowel perforation. Diagnosis Generalized peritonitis secondary to ileal perforation caused by a retained intrauterine device Management Initial management included resuscitation with intravenous fluids, administration of broad-spectrum antibiotics, analgesia, and nasogastric decompression to relieve abdominal distension and prevent vomiting. Despite these measures, the patient’s condition remained critical, necessitating emergency surgical intervention. The patient underwent an emergency laparotomy under general anesthesia. Intraoperative, a 3 cm × 2 cm perforation of the ileum was identified, with an intrauterine device protruding into the intestinal lumen. There was a significant amount of purulent peritoneal fluid, indicating generalized peritonitis, but no involvement of other abdominal organs was noted. Surgical management included ileal resection with end-to-end anastomosis, thorough peritoneal lavage, removal of the migrated intrauterine device, and repair of the uterine wall. Postoperative course The patient was transferred to the intensive care unit for postoperative monitoring, where she received broad-spectrum intravenous antibiotics, pain management, and supportive care. Gradual reintroduction of enteral feeding was initiated as bowel function returned, and her postoperative recovery was closely monitored for complications. Outcome and Follow-up: The patient recovered well postoperatively, with gradual improvement in her clinical condition. Her vital signs and laboratory parameters normalized, and bowel function resumed without complications. She was discharged on the 10th postoperative day in stable condition, with instructions for follow-up. At her one-month review, she remained asymptomatic with no postoperative complications noted. Discussion Uterine perforation with migration of IUD into the gastrointestinal tract is extremely rare, with ileal perforation being one of the least reported events. Risk factors include insertion by inexperienced personnel, long-term retention, and uterine abnormalities ( 3 , 4 ). Clinical presentation may mimic acute abdomen from other causes, making diagnosis challenging. Imaging modalities such as X-ray, ultrasound, or CT scan are valuable for detection. Surgical removal is the treatment of choice to prevent ongoing contamination and sepsis ( 2 ). This case highlights the importance of timely identification of IUD-related complications and early surgical management to prevent morbidity and mortality. Conclusion Although rare, retained intrauterine devices can cause life-threatening gastrointestinal perforation and generalized peritonitis. Clinicians should maintain a high index of suspicion in women presenting with acute abdomen and a history of long-term intrauterine device use. Early surgical intervention is essential for a favorable outcome. Abbreviations CT scan Computed Tomography scan IUD I ntrauterine Contraceptive Device Declarations Disclosure of ethics statement The patient gave written formal informed consent for this case report and any related pictures to be published in case report. In order to undertake all procedures in compliance with applicable rules and legislation of Helsinki declaration to protect human subjects and their data, a formal informed consent form was read and signed. All patient information was kept private. Data availability and materials Data are available on the reasonable request from the corresponding author. Competing interests The authors announce they haven’t interest of conflict. Funding declaration The authors received no funding for this case report. Authors Contributions IGA, DGW , SAK , and KNT were the study contributor. DGW and SAK were involved in patient assessment, management, and bring the case for report. IGA and KNT evidence compilation, write-up, and develop manuscript. All authors were involved in document preparation. Finally, all authors have read, and agreed on the manuscript. Acknowledgment First and foremost, we extend our deepest gratitude to the Almighty God for His unwavering support and guidance throughout the journey of our lives. We would also like to express our sincere appreciation to Ambo University College of Health Sciences and Referral Hospital for their invaluable support and the opportunity to report this case. Our heartfelt thanks go to the study participant and his attendant, whose cooperation and contribution were essential to the success of this work. References Gill RS, Mok D, Hudson M, Shi X, Birch DW, Karmali S. Laparoscopic removal of an intra-abdominal intrauterine device: case and systematic review. Contraception. 2012 Jan;85(1):15–8. Markovitch O, Klein Z, Gidoni Y, Holzinger M, Beyth Y. Extrauterine mislocated IUD: is surgical removal mandatory? Contraception. 2002 Aug;66(2):105–8. Biller J, Winegardner BS, Sleet M. Generalized Peritonitis Secondary to Perforated Uterine Pyometra. Cureus. 2022;14(10):4–9. Kaislasuo J, Suhonen S, Gissler M, Lähteenmäki P, Heikinheimo O. Uterine perforation caused by intrauterine devices: clinical course and treatment. Hum Reprod. 2013 Jun;28(6):1546–51. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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patient\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8011231/v1/32496d4df788d4e4732dd01b.jpeg"},{"id":97720891,"identity":"75ff14c7-43a8-4f2a-9312-26b68dba46b6","added_by":"auto","created_at":"2025-12-08 15:37:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1202950,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIntra operative findings of generalized peritonitis secondary to perforated ileum following retained intrauterine device in a 49-year-old female patient\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8011231/v1/969d362dcf24c9bb59d33a70.png"},{"id":99789187,"identity":"66aa540e-5a85-4b53-8ebc-9577e4f2b4e6","added_by":"auto","created_at":"2026-01-08 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Uterine perforation is an uncommon but serious complication, with the potential to migrate into the peritoneal cavity or adjacent organs. Gastrointestinal perforation caused by a migrated IUD is extremely rare (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Prompt diagnosis and surgical management are essential to reduce morbidity and mortality associated with generalized peritonitis (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 49-year-old female presented with no documented chronic illnesses and a four-day history of generalized abdominal pain that was sudden and included increased abdominal distension, nausea, vomiting, and fever. She has a history of intrauterine device (IUD) insertion 12 years ago. Upon physical examination, she had a fever and her pulse was rapid and weak. Her abdomen was distended and examination yielded generalized tenderness, guarding, and rebound tenderness diagnostic of peritonitis. Other systems were normal. The abdominal X-ray and then subsequent tests were indicative of abuse and later systemic infection due to migration of the foreign body, which was confirmed to be a retained IUD located in the ileum and possible bowel perforation.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e\u003cp\u003eGeneralized peritonitis secondary to ileal perforation caused by a retained intrauterine device\u003c/p\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eManagement\u003c/h2\u003e\u003cp\u003eInitial management included resuscitation with intravenous fluids, administration of broad-spectrum antibiotics, analgesia, and nasogastric decompression to relieve abdominal distension and prevent vomiting. Despite these measures, the patient\u0026rsquo;s condition remained critical, necessitating emergency surgical intervention. The patient underwent an emergency laparotomy under general anesthesia. Intraoperative, a 3 cm \u0026times; 2 cm perforation of the ileum was identified, with an intrauterine device protruding into the intestinal lumen. There was a significant amount of purulent peritoneal fluid, indicating generalized peritonitis, but no involvement of other abdominal organs was noted. Surgical management included ileal resection with end-to-end anastomosis, thorough peritoneal lavage, removal of the migrated intrauterine device, and repair of the uterine wall.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePostoperative course\u003c/h3\u003e\n\u003cp\u003eThe patient was transferred to the intensive care unit for postoperative monitoring, where she received broad-spectrum intravenous antibiotics, pain management, and supportive care. Gradual reintroduction of enteral feeding was initiated as bowel function returned, and her postoperative recovery was closely monitored for complications.\u003c/p\u003e\n\u003ch3\u003eOutcome and Follow-up:\u003c/h3\u003e\n\u003cp\u003eThe patient recovered well postoperatively, with gradual improvement in her clinical condition. Her vital signs and laboratory parameters normalized, and bowel function resumed without complications. She was discharged on the 10th postoperative day in stable condition, with instructions for follow-up. At her one-month review, she remained asymptomatic with no postoperative complications noted.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUterine perforation with migration of IUD into the gastrointestinal tract is extremely rare, with ileal perforation being one of the least reported events. Risk factors include insertion by inexperienced personnel, long-term retention, and uterine abnormalities (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Clinical presentation may mimic acute abdomen from other causes, making diagnosis challenging. Imaging modalities such as X-ray, ultrasound, or CT scan are valuable for detection. Surgical removal is the treatment of choice to prevent ongoing contamination and sepsis (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This case highlights the importance of timely identification of IUD-related complications and early surgical management to prevent morbidity and mortality.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAlthough rare, retained intrauterine devices can cause life-threatening gastrointestinal perforation and generalized peritonitis. Clinicians should maintain a high index of suspicion in women presenting with acute abdomen and a history of long-term intrauterine device use. Early surgical intervention is essential for a favorable outcome.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eCT scan\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputed Tomography scan\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eIUD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cb\u003eI\u003c/b\u003entrauterine Contraceptive Device\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosure of ethics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient gave written formal informed consent for this case report and any related pictures to be published in case report. In order to undertake all procedures in compliance with applicable rules and legislation of Helsinki declaration to protect human subjects and their data, a formal informed consent form was read and signed. All patient information was kept private.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available on the reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors announce they haven\u0026rsquo;t interest of conflict.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no funding for this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc71388640\"\u003e\u003cstrong\u003eIGA, DGW\u003c/strong\u003e, \u003cstrong\u003eSAK\u003c/strong\u003e, and\u003cstrong\u003e\u0026nbsp;KNT\u0026nbsp;\u003c/strong\u003ewere the study contributor.\u003cstrong\u003e\u0026nbsp;DGW\u003c/strong\u003e and\u003cstrong\u003e\u0026nbsp;SAK\u0026nbsp;\u003c/strong\u003ewere involved in patient assessment, management, and bring the case for report. IGA and \u003cstrong\u003eKNT\u0026nbsp;\u003c/strong\u003eevidence compilation, write-up, and develop manuscript. All authors were involved in document preparation. Finally, all authors have read, and agreed on the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst and foremost, we extend our deepest gratitude to the Almighty God for His unwavering support and guidance throughout the journey of our lives. We would also like to express our sincere appreciation to Ambo University College of Health Sciences and Referral Hospital for their invaluable support and the opportunity to report this case. Our heartfelt thanks go to the study participant and his attendant, whose cooperation and contribution were essential to the success of this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGill RS, Mok D, Hudson M, Shi X, Birch DW, Karmali S. Laparoscopic removal of an intra-abdominal intrauterine device: case and systematic review. Contraception. 2012 Jan;85(1):15\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eMarkovitch O, Klein Z, Gidoni Y, Holzinger M, Beyth Y. Extrauterine mislocated IUD: is surgical removal mandatory? Contraception. 2002 Aug;66(2):105\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eBiller J, Winegardner BS, Sleet M. Generalized Peritonitis Secondary to Perforated Uterine Pyometra. Cureus. 2022;14(10):4\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eKaislasuo J, Suhonen S, Gissler M, L\u0026auml;hteenm\u0026auml;ki P, Heikinheimo O. Uterine perforation caused by intrauterine devices: clinical course and treatment. Hum Reprod. 2013 Jun;28(6):1546\u0026ndash;51.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8011231/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8011231/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eGeneralized peritonitis is a life-threatening condition often caused by gastrointestinal perforation. Intrauterine devices are commonly used contraceptive methods, and complications are rare but can include uterine perforation and migration into adjacent organs. The condition arises from the migration of the Intrauterine devices from the uterus into the abdominal cavity, where it can embed in and perforate the small bowel, leading to a severe peritonitis from spilling intestinal contents. We report a rare case of a 49-year-old female who developed generalized peritonitis secondary to ileal perforation caused by a retained intrauterine device. Early recognition and timely surgical intervention were crucial for a favorable outcome.\u003c/p\u003e","manuscriptTitle":"Rare case report of generalized peritonitis secondary to perforated ileum following retained intrauterine device in a 49-year-old female: Successful Surgical Management at Ambo University College of Health Sciences and referral hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 15:37:09","doi":"10.21203/rs.3.rs-8011231/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"79d3b833-8794-45bf-8844-241ecb647af8","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-02T07:39:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 15:37:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8011231","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8011231","identity":"rs-8011231","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}