Small Bowel Necrosis Caused by Migrated Intrauterine Device: A Rare Surgical Emergency

Small Bowel Necrosis Caused by Migrated Intrauterine Device: A Rare Surgical Emergency | 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 Small Bowel Necrosis Caused by Migrated Intrauterine Device: A Rare Surgical Emergency Juan Zhang, Ying-mei Xiao, Mao-Juan Wang, Fan Jiang, Min Chen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9020736/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: The intrauterine device (IUD) is an efficient and commonly used long-term contraceptive method. Although generally safe, its rare yet serious complications—uterine perforation and secondary intra-abdominal migration—can lead to injuries to adjacent organs, such as intestinal perforation, obstruction, or necrosis. IUD displacement into the small intestine causing necrosis is an extremely rare clinical event, with limited reports in the literature. Case presentation: This report describes an 81-year-old female who was admitted due to upper abdominal pain for one day and had a history of IUD placement. One day prior to admission, the patient developed persistent upper abdominal pain accompanied by nausea, vomiting, and cessation of flatus and defecation. Computed tomography (CT) suggested intestinal obstruction, with the possibility of IUD displacement and intestinal ischemia. Intraoperatively, it was observed that a segment of the small intestine had become entrapped within a metal contraceptive ring approximately 3 cm in diameter, resulting in intestinal ischemia and necrosis. The procedures performed included removal of the contraceptive ring, partial ileal resection with anastomosis, and uterine repair. The patient recovered well postoperatively. Conclusions: Although small bowel necrosis caused by IUD displacement is rare, it constitutes a surgical emergency. Clinicians should maintain a high index of suspicion in patients with a history of IUD placement who present with abdominal pain, and promptly conduct imaging evaluation to avoid missed diagnosis and serious consequences. Intrauterine device migration Intestinal obstruction Small bowel necrosis Surgical emergency Figures Figure 1 Figure 2 Background The intrauterine device (IUD) is a highly effective, safe, and reversible long-term contraceptive method widely used worldwide[1-2]. Although the overall incidence of complications is low, uterine perforation and subsequent intra-abdominal migration of the IUD represent a rare yet serious complication that can pose significant risks to patients[3]. According to the literature, the incidence of uterine perforation is approximately 0.1%[4]. In some cases, the IUD may penetrate the uterine wall and migrate into the abdominal cavity, potentially involving adjacent organs[5-6]. Intra-abdominally displaced IUDs may involve structures such as the intestines, bladder, and omentum, leading to severe complications including intestinal adhesions, obstruction, perforation, and even intestinal ischemia and necrosis[7-8]. Among these, small bowel necrosis caused by IUD migration is an extremely rare clinical event[9]. The clinical manifestations in such patients are often nonspecific, making early diagnosis challenging and frequently leading to misdiagnosis as common acute abdominal conditions[10]. This delay in diagnosis can result in postponed surgical intervention, potentially endangering the patient's life. Therefore, enhancing clinicians' awareness of intestinal necrosis caused by IUD displacement, improving imaging evaluation protocols, and implementing timely surgical intervention are of significant importance for improving patient prognosis. This article reports a case of an 81-year-old female with small bowel necrosis induced by IUD migration, aiming to raise awareness of this rare emergency and provide reference for clinical diagnosis and management. Case Description An 81-year-old female was admitted to the emergency department on November 24, 2025, due to upper abdominal pain for one day.One day prior to admission, she developed persistent upper abdominal pain without an obvious cause, which radiated to the back and was accompanied by nausea, vomiting, and cessation of flatus and defecation. Her medical history includes pancreatitis and primary thrombocythemia, both diagnosed 10 years ago.She denied any history of chronic conditions such as hypertension, diabetes, or heart disease.On physical examination, her vital signs were as follows: temperature 36.8°C, pulse 65 beats/min, respiratory rate 16 breaths/min, and blood pressure 212/116 mmHg. She appeared distressed, with diffuse abdominal tenderness and muscle guarding.Laboratory tests revealed a significantly elevated white blood cell count of 29.22×10⁹/L and an increased neutrophil percentage of 89.4%. Procalcitonin was mildly elevated at 0.085 ng/mL. Blood gas analysis, liver and kidney function tests, and coagulation profiles showed no significant abnormalities.Contrast-enhanced CT of the abdomen and pelvis demonstrated long-segment dilation of the small intestine in the lower abdomen and pelvis, with a maximum diameter of approximately 2.6 cm. The images revealed multiple fluid collections and a small amount of gas within the bowel lumen. The small bowel in the lower abdomen and pelvis exhibited a U-shaped configuration, accompanied by a mesenteric whirl sign indicating slight intestinal torsion, significant mesenteric edema, and reduced bowel wall enhancement. These findings were consistent with intestinal obstruction, raising concern for intestinal ischemia. Additionally, scattered fluid was noted in the abdominal and pelvic cavities. A circular dense shadow was observed within the pelvic mesentery (Figure 1). Based on the clinical and imaging findings, the preliminary diagnosis included intestinal torsion, intestinal obstruction, and possible intestinal ischemia necrosis. Emergency exploratory laparotomy was performed. Intraoperatively, a displaced IUD was identified. Approximately 300 mL of bloody fluid was present in the abdominal cavity. A 30-cm segment of the small intestine was found to be entrapped within a metal contraceptive ring measuring about 3 cm in diameter, resulting in intestinal ischemia and necrosis. A 0.5-cm perforation was noted on the anterior uterine wall. The intraoperative findings are illustrated in Figure 2. Surgical intervention included resection of the necrotic ileal segment with anastomosis and repair of the uterine perforation. Postoperatively, the patient was transferred to the intensive care unit (ICU) for further management. Treatment included intravenous cefoperazone-sulbactam (2 g every 8 hours) for infection prophylaxis, fluid resuscitation, analgesia, and nutritional support. Her condition stabilized, and the endotracheal tube was removed on November 25. She was transferred from the ICU to the gastrointestinal surgery department on November 26 and was discharged on December 6 after an uneventful recovery. Discussion Mechanisms and Risk Factors of IUD Displacement Intra-abdominal migration of an IUD is a rare yet serious long-term complication. Most cases are asymptomatic or present with nonspecific symptoms, often overlooked until severe visceral injury occurs and prompts diagnosis[11]. Displacement may ccur immediately upon insertion or as a result of delayed migration due to uterine contractions and long-term pressure from the IUD on the myometrium [10，11-12]. Known risk factors include placement within 6–8 weeks postpartum or post-abortion, abnormal uterine positions such as severe anteversion or retroversion, and insufficient operator experience [13-15]. Once the IUD enters the abdominal cavity, it may migrate asymptomatically for an extended period. Ultimately, due to intestinal peristalsis, inflammatory adhesion formation, and direct pressure necrosis, it can lead to complications such as intestinal obstruction, perforation, or ischemic necrosis[16-17]. Diagnostic Challenges and the Pivotal Role of Imaging The clinical manifestations of an intra-abdominally displaced IUD are often nonspecific and variable, ranging from chronic intermittent abdominal pain, as seen in the early stages of this case, to acute presentations resembling common abdominal emergencies such as appendicitis or simple intestinal obstruction, which can easily lead to diagnostic delays[18]. In this context, imaging studies are of paramount importance. While pelvic ultrasound and plain abdominal radiographs may suggest an extrauterine IUD, contrast-enhanced computed tomography is crucial for definitive diagnosis and surgical planning[19]. As demonstrated in this case, CT precisely localized the IUD, clearly revealed its intimate relationship with the small bowel, and critically identified signs of intestinal injury. This comprehensive assessment directly informed the decision for emergency surgical intervention. Treatment Principles and Surgical Options Once visceral injury caused by an intra-abdominal IUD is suspected or confirmed, surgical removal is mandatory [20]. The choice of surgical approach depends on the location of the IUD, the severity of associated complications, and the surgeon’s experience. For hemodynamically stable patients, laparoscopic exploration and retrieval are the preferred options, offering the advantages of minimally invasive surgery, including improved visualization of the pelvic and upper abdominal regions, reduced postoperative pain, and faster recovery [21-22]. However, in cases where definite intestinal necrosis is present, as observed in this patient, open laparotomy remains the standard therapeutic approach[23]. The surgical objectives should include complete removal of the foreign body, thorough examination of the entire gastrointestinal tract to rule out other injuries such as those involving the colon, bladder, or omentum , and appropriate management of the complications[24]. For ischemic or necrotic bowel segments, segmental resection with primary anastomosis is required. Concurrently, any uterine defect should be repaired by suturing[25-26]. Conclusion This report demonstrates that although IUD displacement secondary to small bowel necrosis is extremely rare, it constitutes a genuine surgical emergency that can be life-threatening. It emphasizes that for any female patient presenting with acute or chronic abdominal pain, a history of IUD placement should be actively inquired about. A high degree of clinical suspicion must be combined with abdominal contrast-enhanced CT for early diagnosis. Prompt surgical intervention is the only curative treatment approach. As a typical case, this report serves as a critical reminder of the rare yet severe long-term complications that may arise from a commonly used medical device. Declarations Ethical Approval and Consent to participate This study was approved by the Ethics Committee of De Yang People’s Hospital. The case report was conducted in accordance with the ethical standards of both the institutional and national research committees, as well as the principles outlined in the Helsinki Declaration. Written informed consent for participation in clinical management and data collection was obtained from the patient’s next of kin and is properly documented. Consent for publication Explicit written consent for the publication of this case report and any accompanying visual materials was obtained from the patient’s next of kin in accordance with ethical guidelines. Availability of supporting data The data supporting the findings of this case report are fully available within the manuscript. Competing interests The authors declare that they have no competing interests. Funding No funding. Clinical trial number Not applicable. Authors' contributions JZ contributed to the clinical management, data collection, and drafting of the manuscript. YMX supervised the clinical care, revised the manuscript critically, and approved the final version. MJW participated in the patient’s management and assisted in manuscript preparation. FJ performed the surgical intervention and assisted in imaging analysis. MC contributed to data curation and literature review. XHH participated in the literature search and manuscript editing. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Aliukonis V, Lasinskas M, Pilvelis A, Gradauskas A. Intrauterine device migration into the lumen of large bowel: A case report. Int J Surg Case Rep. 2020;72:306-308. Rahnemai-Azar AA, Apfel T, Naghshizadian R, Cosgrove JM, Farkas DT. Laparoscopic removal of migrated intrauterine device embedded in intestine. JSLS. 2014 Jul-Sep;18(3):e2014.00122. Song HX, Xie TH, Fu Y, Jin XS, Wang Q, Niu Z, Sun Q, An XH. Case Report: Strangulated intestinal obstruction due to chronic migration of an intrauterine device (IUD): a 30-year latent complication. Front Med (Lausanne). 2025 Jul 7;12:1613116. Goldsamt A, Lord JL, Alessio ND. Intraperitoneal Levonorgestrel-Releasing Intrauterine Device in a Patient With a Kidney Stone: A Case Report. Cureus. 2025 Oct 23;17(10):e95251. Alrowili F, Albaish LJ, Alabduljabbar KH. Intrauterine Device Migration Into the Rectum: A Case Report. Cureus. 2025 Apr 26;17(4):e83036. Malki EG, Sbeih D, Bael P, Alsarabta H, Alzawahra A. The rolling stone: migration of an intrauterine device leading to bladder stone formation nine years after insertion: a case report. BMC Urol. 2025 Apr 17;25(1):93. Jing J. Case report: An intrauterine device hugging the musculus rectus abdominis through the center of a cesarean scar. Front Surg. 2023 Jan 6;9:956856. Han JH, Yu EH, Joo JK, Kim MJ, Choi JB, Jung HJ, Jo HJ, Lee BC. Laparoscopic management of bowel perforation secondary to levonorgestrel-releasing intrauterine device migration: a case report and review of literature. J Surg Case Rep. 2024 Aug 30;2024(8):rjae522. Yu F, Chen M, Cao H, Yang G, Wang W, Wang Y. Intrauterine device (IUD) migration completely into the abdominal cavity and half into the bladder to form a stone: a case report and mini-review. BMC Urol. 2024 Dec 23;24(1):280. Boushehry R, Al-Taweel T, Bandar A, Hasan M, Atnuos M, Alkhamis A. Rare case of rectal perforation by an intrauterine device: Case report and review of the literature. Int J Surg Case Rep. 2022 Oct;99:107610. Verstraeten V, Vossaert K, Van den Bosch T. Migration of Intra-Uterine Devices. Open Access J Contracept. 2024 Mar 12;15:41-47. Akad M, Tardif D, Fawzy A, Socolov RV. Management of an Intrauterine Device Migration Resulting in a Pregnancy - Clinical Case. Maedica (Bucur). 2020 Dec;15(4):549-551. Tani MK, Farda W, Khan H, Malikzai O, Sharif Z. Missing intrauterine device migrated to terminal ileum resembling adnexal mass: A case report. Int J Surg Case Rep. 2024 Feb;115:109279. Cheung ML, Rezai S, Jackman JM, Patel ND, Bernaba BZ, Hakimian O, Nuritdinova D, Turley CL, Mercado R, Takeshige T, Reddy SM, Fuller PN, Henderson CE. Retained Intrauterine Device (IUD): Triple Case Report and Review of the Literature. Case Rep Obstet Gynecol. 2018 Dec 5;2018:9362962. Benchaou H, Boukroute M, Aouragh A, Aloua YE, Regragui A, Bellajdel I, Chetbi Z, Taheri H, Saadi H, Mimouni A. Severe complications of intrauterine device migration: Case reports of rectal perforation and omental localization. Radiol Case Rep. 2024 Aug 5;19(10):4544-4548. Carroll A, Paradise C, Schuemann K, Schellhammer SS, Carlan SJ. Far migration of an intrauterine contraceptive device from the uterus to the small bowel. Clin Case Rep. 2022 Mar 13;10(3):e05589. Tabatabaei F, Hosseini STN, Hakimi P, Vejdani R, Khademi B. Risk factors of uterine perforation when using contraceptive intrauterine devices. BMC Womens Health. 2024 Sep 27;24(1):538. Benaguida H, Kiram H, Telmoudi EC, Ouafidi B, Benhessou M, Ennachit M, Elkarroumi M. Intraperitoneal migration of an intrauterine device (IUD): A case report. Ann Med Surg (Lond). 2021 Jul 8;68:102547. Gómez-Arciniega KD, Palomares-Castillo ED, Benítez-Jauregui HA, Gastelum-Sarabia JR, Ayala-López MD. Perforation, Migration, and Omentum Embedding of a Levonorgestrel Intrauterine Device: A Case Report. Cureus. 2024 Aug 19;16(8):e67198. Lee J, Oh JH, Kim J, Lim CH, Jung SH. Incomplete Removal of an Intrauterine Device Perforating the Sigmoid Colon. Korean J Gastroenterol. 2021 Jul 25;78(1):48-52. Li Q, Qi D, Bi T, Guo X, Chen H. Case report: Uterine perforation caused by migration of intrauterine devices. Front Med (Lausanne). 2024 Sep 5;11:1455207. Simwa MA, Karwal S, Ibrahim S, Dave A, Alsobhi A, Mensah E, Hani M. Silent Migration of an Intrauterine Device into the Peritoneum: A Case Report. Cureus. 2025 Oct 22;17(10):e95176. Alharbi KY, Filimban HA, Bafageeh SW, Binaqeel AS, Bayzid MA, Brasha NM. Removal of a Migrated Intrauterine Contraceptive Device Perforating the Terminal Ileum: A Case Report. Cureus. 2022 Sep 29;14(9):e29748. Kabilan VR, Prabhu JK, Thiagarajan S, Muthulingam D, Priyankaa NY. Forgotten Intrauterine Contraceptive Device Presenting as Vesicouterine Fistula - Migration or Misadventure. J Midlife Health. 2025 Apr-Jun;16(2):221-223. Isikhuemen ME, Idolor AG, Uwagboe CU, Sodje JDK, Anya CJ, Okonofua FE. Case report of an unusual finding of intrauterine contraceptive device in the rectum. Int J Surg Case Rep. 2024 Mar;116:109436. Das A, Joseph TS, Siva Sankar Reddy G, Pipara A, Mukhopadhyay S. Migrated Foreign Body Perforating the Colon: Scope for Colonoscopy. Cureus. 2025 Jan 28;17(1):e78112. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 May, 2026 Reviews received at journal 03 May, 2026 Reviews received at journal 30 Apr, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviews received at journal 23 Apr, 2026 Reviewers agreed at journal 21 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers invited by journal 16 Apr, 2026 Editor assigned by journal 05 Mar, 2026 Submission checks completed at journal 05 Mar, 2026 First submitted to journal 03 Mar, 2026 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9020736","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":628556206,"identity":"74ce91c6-e1ec-4c99-9e72-9a622de204db","order_by":0,"name":"Juan Zhang","email":"","orcid":"","institution":"Deyang People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"Zhang","suffix":""},{"id":628556207,"identity":"d5d5dd3c-3bcc-4ce8-8771-879cebd6552b","order_by":1,"name":"Ying-mei Xiao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBACNv72AwYJFRI8/PwNiQ8SKmoIa+GTOJNQ8OGMhZzkjAOPDR6cOUZYixxDgsHHmW0VxgYNic8kH7YwE+EwhgOJm3nYJBI3MBxOq0hsYGPgb+9OwK+FufGwMQ+PROJ25ra0G4k7ZBgkzpzdQMiWNGMeCYnEnQ1ngFrOsDEYSOQS0pJg/pvHAOiwA/nfChLbmInSYmA4I0HC2OBAQhoDcVqAgWzw4YAEKJCTJRLOHOMh6Bf5fmBUJv6rA0flxx8VNXL87b34tWAAHtKUj4JRMApGwSjACgAvjU4DHa5YywAAAABJRU5ErkJggg==","orcid":"","institution":"Deyang People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ying-mei","middleName":"","lastName":"Xiao","suffix":""},{"id":628556208,"identity":"eb777e4e-6feb-4506-b196-597a7d2e2413","order_by":2,"name":"Mao-Juan Wang","email":"","orcid":"","institution":"Deyang People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mao-Juan","middleName":"","lastName":"Wang","suffix":""},{"id":628556209,"identity":"0c0d7c01-d99d-4cf6-9858-de09c53195fe","order_by":3,"name":"Fan Jiang","email":"","orcid":"","institution":"Deyang People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fan","middleName":"","lastName":"Jiang","suffix":""},{"id":628556210,"identity":"16e1a728-a262-46b3-a887-a98773963a4f","order_by":4,"name":"Min Chen","email":"","orcid":"","institution":"Deyang People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Chen","suffix":""},{"id":628556212,"identity":"36443322-b353-4130-9279-c867c75c7a8f","order_by":5,"name":"Xia-hong Huang","email":"","orcid":"","institution":"Deyang People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xia-hong","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2026-03-03 13:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9020736/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9020736/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107833811,"identity":"ae2b00b2-1a5b-47cc-957a-935fdb91d5f3","added_by":"auto","created_at":"2026-04-26 15:41:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":500850,"visible":true,"origin":"","legend":"\u003cp\u003eCT revealed an intrauterine device malposition and small bowel dilation. The red arrow indicates the malpositioned intrauterine device\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9020736/v1/4e15b7787b0873b53b616fb9.png"},{"id":107833812,"identity":"8bcdc997-3607-4c44-a506-fea4d82f6c90","added_by":"auto","created_at":"2026-04-26 15:41:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":973747,"visible":true,"origin":"","legend":"\u003cp\u003esmall bowel necrosis was observed due to a displaced intrauterine device .The red arrow indicates the malpositioned intrauterine device.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9020736/v1/28488f45baad3f254483de15.png"},{"id":107869400,"identity":"475975b4-b655-4462-b160-d286bc35719f","added_by":"auto","created_at":"2026-04-27 07:36:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2066429,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9020736/v1/c7ad29c2-4931-4c7a-a3a5-4769a08f4ee9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Small Bowel Necrosis Caused by Migrated Intrauterine Device: A Rare Surgical Emergency","fulltext":[{"header":"Background","content":"\u003cp\u003eThe intrauterine device (IUD) is a highly effective, safe, and reversible long-term contraceptive method widely used worldwide[1-2]. Although the overall incidence of complications is low, uterine perforation and subsequent intra-abdominal migration of the IUD represent a rare yet serious complication that can pose significant risks to patients[3]. According to the literature, the incidence of uterine perforation is approximately 0.1%[4]. In some cases, the IUD may penetrate the uterine wall and migrate into the abdominal cavity, potentially involving adjacent organs[5-6].\u003c/p\u003e\n\u003cp\u003eIntra-abdominally displaced IUDs may involve structures such as the intestines, bladder, and omentum, leading to severe complications including intestinal adhesions, obstruction, perforation, and even intestinal ischemia and necrosis[7-8]. Among these, small bowel necrosis caused by IUD migration is an extremely rare clinical event[9]. The clinical manifestations in such patients are often nonspecific, making early diagnosis challenging and frequently leading to misdiagnosis as common acute abdominal conditions[10]. This delay in diagnosis can result in postponed surgical intervention, potentially endangering the patient\u0026apos;s life. Therefore, enhancing clinicians\u0026apos; awareness of intestinal necrosis caused by IUD displacement, improving imaging evaluation protocols, and implementing timely surgical intervention are of significant importance for improving patient prognosis. This article reports a case of an 81-year-old female with small bowel necrosis induced by IUD migration, aiming to raise awareness of this rare emergency and provide reference for clinical diagnosis and management.\u003c/p\u003e"},{"header":"Case Description","content":"\u003cp\u003eAn 81-year-old female was admitted to the emergency department on November 24, 2025, due to upper abdominal pain for one day.One day prior to admission, she developed persistent upper abdominal pain without an obvious cause, which radiated to the back and was accompanied by nausea, vomiting, and cessation of flatus and defecation. Her medical history includes pancreatitis and primary thrombocythemia, both diagnosed 10 years ago.She denied any history of chronic conditions such as hypertension, diabetes, or heart disease.On physical examination, her vital signs were as follows: temperature 36.8\u0026deg;C, pulse 65 beats/min, respiratory rate 16 breaths/min, and blood pressure 212/116 mmHg. She appeared distressed, with diffuse abdominal tenderness and muscle guarding.Laboratory tests revealed a significantly elevated white blood cell count of 29.22\u0026times;10⁹/L and an increased neutrophil percentage of 89.4%. Procalcitonin was mildly elevated at 0.085 ng/mL. Blood gas analysis, liver and kidney function tests, and coagulation profiles showed no significant abnormalities.Contrast-enhanced CT of the abdomen and pelvis demonstrated long-segment dilation of the small intestine in the lower abdomen and pelvis, with a maximum diameter of approximately 2.6 cm. The images revealed multiple fluid collections and a small amount of gas within the bowel lumen. The small bowel in the lower abdomen and pelvis exhibited a U-shaped configuration, accompanied by a mesenteric whirl sign indicating slight intestinal torsion, significant mesenteric edema, and reduced bowel wall enhancement. These findings were consistent with intestinal obstruction, raising concern for intestinal ischemia. Additionally, scattered fluid was noted in the abdominal and pelvic cavities. A circular dense shadow was observed within the pelvic mesentery (Figure 1).\u003c/p\u003e\n\u003cp\u003eBased on the clinical and imaging findings, the preliminary diagnosis included intestinal torsion, intestinal obstruction, and possible intestinal ischemia necrosis. Emergency exploratory laparotomy was performed. Intraoperatively, a displaced IUD was identified. Approximately 300 mL of bloody fluid was present in the abdominal cavity. A 30-cm segment of the small intestine was found to be entrapped within a metal contraceptive ring measuring about 3 cm in diameter, resulting in intestinal ischemia and necrosis. A 0.5-cm perforation was noted on the anterior uterine wall. The intraoperative findings are illustrated in Figure 2.\u003c/p\u003e\n\u003cp\u003eSurgical intervention included resection of the necrotic ileal segment with anastomosis and repair of the uterine perforation. Postoperatively, the patient was transferred to the intensive care unit (ICU) for further management. Treatment included intravenous cefoperazone-sulbactam (2 g every 8 hours) for infection prophylaxis, fluid resuscitation, analgesia, and nutritional support. Her condition stabilized, and the endotracheal tube was removed on November 25. She was transferred from the ICU to the gastrointestinal surgery department on November 26 and was discharged on December 6 after an uneventful recovery.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eMechanisms and Risk Factors of IUD Displacement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntra-abdominal migration of an IUD is a rare yet serious long-term complication. Most cases are asymptomatic or present with nonspecific symptoms, often overlooked until severe visceral injury occurs and prompts diagnosis[11]. Displacement may ccur immediately upon insertion or as a result of delayed migration due to uterine contractions and long-term pressure from the IUD on the myometrium [10，11-12]. Known risk factors include placement within 6\u0026ndash;8 weeks postpartum or post-abortion, abnormal uterine positions such as severe anteversion or retroversion, and insufficient operator experience [13-15]. Once the IUD enters the abdominal cavity, it may migrate asymptomatically for an extended period. Ultimately, due to intestinal peristalsis, inflammatory adhesion formation, and direct pressure necrosis, it can lead to complications such as intestinal obstruction, perforation, or ischemic necrosis[16-17].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Challenges and the Pivotal Role of Imaging\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical manifestations of an intra-abdominally displaced IUD are often nonspecific and variable, ranging from chronic intermittent abdominal pain, as seen in the early stages of this case, to acute presentations resembling common abdominal emergencies such as appendicitis or simple intestinal obstruction, which can easily lead to diagnostic delays[18]. In this context, imaging studies are of paramount importance. While pelvic ultrasound and plain abdominal radiographs may suggest an extrauterine IUD, contrast-enhanced computed tomography is crucial for definitive diagnosis and surgical planning[19]. As demonstrated in this case, CT precisely localized the IUD, clearly revealed its intimate relationship with the small bowel, and critically identified signs of intestinal injury. This comprehensive assessment directly informed the decision for emergency surgical intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment Principles and Surgical Options\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Once visceral injury caused by an intra-abdominal IUD is suspected or confirmed, surgical removal is mandatory [20]. The choice of surgical approach depends on the location of the IUD, the severity of associated complications, and the surgeon\u0026rsquo;s experience. For hemodynamically stable patients, laparoscopic exploration and retrieval are the preferred options, offering the advantages of minimally invasive surgery, including improved visualization of the pelvic and upper abdominal regions, reduced postoperative pain, and faster recovery [21-22]. However, in cases where definite intestinal necrosis is present, as observed in this patient, open laparotomy remains the standard therapeutic approach[23]. The surgical objectives should include complete removal of the foreign body, thorough examination of the entire gastrointestinal tract to rule out other injuries such as those involving the colon, bladder, or omentum , and appropriate management of the complications[24]. For ischemic or necrotic bowel segments, segmental resection with primary anastomosis is required. Concurrently, any uterine defect should be repaired by suturing[25-26].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis report demonstrates that although IUD displacement secondary to small bowel necrosis is extremely rare, it constitutes a genuine surgical emergency that can be life-threatening. It emphasizes that for any female patient presenting with acute or chronic abdominal pain, a history of IUD placement should be actively inquired about. A high degree of clinical suspicion must be combined with abdominal contrast-enhanced CT for early diagnosis. Prompt surgical intervention is the only curative treatment approach. As a typical case, this report serves as a critical reminder of the rare yet severe long-term complications that may arise from a commonly used medical device.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of De Yang People\u0026rsquo;s Hospital. The case report was conducted in accordance with the ethical standards of both the institutional and national research committees, as well as the principles outlined in the Helsinki Declaration. Written informed consent for participation in clinical management and data collection was obtained from the patient\u0026rsquo;s next of kin and is properly documented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExplicit written consent for the publication of this case report and any accompanying visual materials was obtained from the patient\u0026rsquo;s next of kin in accordance with ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of supporting data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this case report are fully available within the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJZ contributed to the clinical management, data collection, and drafting of the manuscript. YMX supervised the clinical care, revised the manuscript critically, and approved the final version. MJW participated in the patient\u0026rsquo;s management and assisted in manuscript preparation. FJ performed the surgical intervention and assisted in imaging analysis. MC contributed to data curation and literature review. XHH participated in the literature search and manuscript editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAliukonis V, Lasinskas M, Pilvelis A, Gradauskas A. Intrauterine device migration into the lumen of large bowel: A case report. Int J Surg Case Rep. 2020;72:306-308.\u003c/li\u003e\n\u003cli\u003eRahnemai-Azar AA, Apfel T, Naghshizadian R, Cosgrove JM, Farkas DT. Laparoscopic removal of migrated intrauterine device embedded in intestine. JSLS. 2014 Jul-Sep;18(3):e2014.00122.\u003c/li\u003e\n\u003cli\u003eSong HX, Xie TH, Fu Y, Jin XS, Wang Q, Niu Z, Sun Q, An XH. Case Report: Strangulated intestinal obstruction due to chronic migration of an intrauterine device (IUD): a 30-year latent complication. Front Med (Lausanne). 2025 Jul 7;12:1613116.\u003c/li\u003e\n\u003cli\u003eGoldsamt A, Lord JL, Alessio ND. Intraperitoneal Levonorgestrel-Releasing Intrauterine Device in a Patient With a Kidney Stone: A Case Report. Cureus. 2025 Oct 23;17(10):e95251.\u003c/li\u003e\n\u003cli\u003eAlrowili F, Albaish LJ, Alabduljabbar KH. Intrauterine Device Migration Into the Rectum: A Case Report. Cureus. 2025 Apr 26;17(4):e83036.\u003c/li\u003e\n\u003cli\u003eMalki EG, Sbeih D, Bael P, Alsarabta H, Alzawahra A. The rolling stone: migration of an intrauterine device leading to bladder stone formation nine years after insertion: a case report. BMC Urol. 2025 Apr 17;25(1):93.\u003c/li\u003e\n\u003cli\u003eJing J. Case report: An intrauterine device hugging the musculus rectus abdominis through the center of a cesarean scar. Front Surg. 2023 Jan 6;9:956856.\u003c/li\u003e\n\u003cli\u003eHan JH, Yu EH, Joo JK, Kim MJ, Choi JB, Jung HJ, Jo HJ, Lee BC. Laparoscopic management of bowel perforation secondary to levonorgestrel-releasing intrauterine device migration: a case report and review of literature. J Surg Case Rep. 2024 Aug 30;2024(8):rjae522. \u003c/li\u003e\n\u003cli\u003eYu F, Chen M, Cao H, Yang G, Wang W, Wang Y. Intrauterine device (IUD) migration completely into the abdominal cavity and half into the bladder to form a stone: a case report and mini-review. BMC Urol. 2024 Dec 23;24(1):280. \u003c/li\u003e\n\u003cli\u003eBoushehry R, Al-Taweel T, Bandar A, Hasan M, Atnuos M, Alkhamis A. Rare case of rectal perforation by an intrauterine device: Case report and review of the literature. Int J Surg Case Rep. 2022 Oct;99:107610.\u003c/li\u003e\n\u003cli\u003eVerstraeten V, Vossaert K, Van den Bosch T. Migration of Intra-Uterine Devices. Open Access J Contracept. 2024 Mar 12;15:41-47. \u003c/li\u003e\n\u003cli\u003eAkad M, Tardif D, Fawzy A, Socolov RV. Management of an Intrauterine Device Migration Resulting in a Pregnancy - Clinical Case. Maedica (Bucur). 2020 Dec;15(4):549-551. \u003c/li\u003e\n\u003cli\u003eTani MK, Farda W, Khan H, Malikzai O, Sharif Z. Missing intrauterine device migrated to terminal ileum resembling adnexal mass: A case report. Int J Surg Case Rep. 2024 Feb;115:109279.\u003c/li\u003e\n\u003cli\u003eCheung ML, Rezai S, Jackman JM, Patel ND, Bernaba BZ, Hakimian O, Nuritdinova D, Turley CL, Mercado R, Takeshige T, Reddy SM, Fuller PN, Henderson CE. Retained Intrauterine Device (IUD): Triple Case Report and Review of the Literature. Case Rep Obstet Gynecol. 2018 Dec 5;2018:9362962.\u003c/li\u003e\n\u003cli\u003eBenchaou H, Boukroute M, Aouragh A, Aloua YE, Regragui A, Bellajdel I, Chetbi Z, Taheri H, Saadi H, Mimouni A. Severe complications of intrauterine device migration: Case reports of rectal perforation and omental localization. Radiol Case Rep. 2024 Aug 5;19(10):4544-4548.\u003c/li\u003e\n\u003cli\u003eCarroll A, Paradise C, Schuemann K, Schellhammer SS, Carlan SJ. Far migration of an intrauterine contraceptive device from the uterus to the small bowel. Clin Case Rep. 2022 Mar 13;10(3):e05589.\u003c/li\u003e\n\u003cli\u003eTabatabaei F, Hosseini STN, Hakimi P, Vejdani R, Khademi B. Risk factors of uterine perforation when using contraceptive intrauterine devices. BMC Womens Health. 2024 Sep 27;24(1):538. \u003c/li\u003e\n\u003cli\u003eBenaguida H, Kiram H, Telmoudi EC, Ouafidi B, Benhessou M, Ennachit M, Elkarroumi M. Intraperitoneal migration of an intrauterine device (IUD): A case report. Ann Med Surg (Lond). 2021 Jul 8;68:102547.\u003c/li\u003e\n\u003cli\u003eG\u0026oacute;mez-Arciniega KD, Palomares-Castillo ED, Ben\u0026iacute;tez-Jauregui HA, Gastelum-Sarabia JR, Ayala-L\u0026oacute;pez MD. Perforation, Migration, and Omentum Embedding of a Levonorgestrel Intrauterine Device: A Case Report. Cureus. 2024 Aug 19;16(8):e67198.\u003c/li\u003e\n\u003cli\u003eLee J, Oh JH, Kim J, Lim CH, Jung SH. Incomplete Removal of an Intrauterine Device Perforating the Sigmoid Colon. Korean J Gastroenterol. 2021 Jul 25;78(1):48-52.\u003c/li\u003e\n\u003cli\u003eLi Q, Qi D, Bi T, Guo X, Chen H. Case report: Uterine perforation caused by migration of intrauterine devices. Front Med (Lausanne). 2024 Sep 5;11:1455207. \u003c/li\u003e\n\u003cli\u003eSimwa MA, Karwal S, Ibrahim S, Dave A, Alsobhi A, Mensah E, Hani M. Silent Migration of an Intrauterine Device into the Peritoneum: A Case Report. Cureus. 2025 Oct 22;17(10):e95176.\u003c/li\u003e\n\u003cli\u003eAlharbi KY, Filimban HA, Bafageeh SW, Binaqeel AS, Bayzid MA, Brasha NM. Removal of a Migrated Intrauterine Contraceptive Device Perforating the Terminal Ileum: A Case Report. Cureus. 2022 Sep 29;14(9):e29748.\u003c/li\u003e\n\u003cli\u003eKabilan VR, Prabhu JK, Thiagarajan S, Muthulingam D, Priyankaa NY. Forgotten Intrauterine Contraceptive Device Presenting as Vesicouterine Fistula - Migration or Misadventure. J Midlife Health. 2025 Apr-Jun;16(2):221-223. \u003c/li\u003e\n\u003cli\u003eIsikhuemen ME, Idolor AG, Uwagboe CU, Sodje JDK, Anya CJ, Okonofua FE. Case report of an unusual finding of intrauterine contraceptive device in the rectum. Int J Surg Case Rep. 2024 Mar;116:109436.\u003c/li\u003e\n\u003cli\u003eDas A, Joseph TS, Siva Sankar Reddy G, Pipara A, Mukhopadhyay S. Migrated Foreign Body Perforating the Colon: Scope for Colonoscopy. Cureus. 2025 Jan 28;17(1):e78112. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Intrauterine device migration, Intestinal obstruction, Small bowel necrosis, Surgical emergency","lastPublishedDoi":"10.21203/rs.3.rs-9020736/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9020736/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe intrauterine device (IUD) is an efficient and commonly used long-term contraceptive method. Although generally safe, its rare yet serious complications—uterine perforation and secondary intra-abdominal migration—can lead to injuries to adjacent organs, such as intestinal perforation, obstruction, or necrosis. IUD displacement into the small intestine causing necrosis is an extremely rare clinical event, with limited reports in the literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation: \u003c/strong\u003eThis report describes an 81-year-old female who was admitted due to upper abdominal pain for one day and had a history of IUD placement. One day prior to admission, the patient developed persistent upper abdominal pain accompanied by nausea, vomiting, and cessation of flatus and defecation. Computed tomography (CT) suggested intestinal obstruction, with the possibility of IUD displacement and intestinal ischemia. Intraoperatively, it was observed that a segment of the small intestine had become entrapped within a metal contraceptive ring approximately 3 cm in diameter, resulting in intestinal ischemia and necrosis. The procedures performed included removal of the contraceptive ring, partial ileal resection with anastomosis, and uterine repair. The patient recovered well postoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eAlthough small bowel necrosis caused by IUD displacement is rare, it constitutes a surgical emergency. Clinicians should maintain a high index of suspicion in patients with a history of IUD placement who present with abdominal pain, and promptly conduct imaging evaluation to avoid missed diagnosis and serious consequences.\u003c/p\u003e","manuscriptTitle":"Small Bowel Necrosis Caused by Migrated Intrauterine Device: A Rare Surgical Emergency","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-26 15:41:03","doi":"10.21203/rs.3.rs-9020736/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-11T11:48:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T18:32:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T15:45:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225175795518208004459501747977274137147","date":"2026-04-30T07:29:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"47429218750409911057805227469607281606","date":"2026-04-23T18:59:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T14:07:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266969045133870914777874107375026596526","date":"2026-04-21T18:12:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58162793088039683453603870635788202582","date":"2026-04-16T19:25:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"264585717458871580885567607761798307295","date":"2026-04-16T14:53:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-16T13:45:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-05T06:29:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-05T06:24:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Emergency Medicine","date":"2026-03-03T13:26:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"42b94ad2-babe-4f46-a6d6-5be21cb16a4d","owner":[],"postedDate":"April 26th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-11T11:48:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T18:32:16+00:00","index":56,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T15:45:49+00:00","index":55,"fulltext":""},{"type":"reviewerAgreed","content":"225175795518208004459501747977274137147","date":"2026-04-30T07:29:24+00:00","index":54,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T16:08:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-26 15:41:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9020736","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9020736","identity":"rs-9020736","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}