Intrauterine device (IUD) is one of the most commonly used long-acting reversible contraceptives (LARCs) method worldwide. IUD may pose some disadvantages regarding its use and may cause unwanted events. IUD displacement with both arms embedded through myometrial tissue is one of the unwanted events that could occur rarely. This condition has been confered a diagnostic challenge to many physicians . However, most cases could accurately be detected using 3D transvaginal sonography. Management of IUD displacement with invisible arms is very challenging that needs to be performed cautiously. Hysteroscopic evaluation and treatment may be the last resort when other approaches fail.

A 33-year-old female had had Nova T IUD inserted during caesarean section one year before presentation. The patient had no remarkable medical history except for myomectomy performed two years earlier. She was about to have another pregnancy so she needed to get her IUD removed. 2D and 3D transvginal sonography was performed to confirm IUD position. Sonography results showed displacement of IUD with both arms embedded through myometrial layer. Hysteroscopic evaluation under regional anesthesia was then performed to evaluate this condition. Hysteroscopic views did not reveal the IUD arm but IUD stem that was transversely displaced suggesting the both arms was deeply embedded into myometrial layer. Hysteroscopic removal was then performed with astonishing result. Post-procedural condition was uneventful without any significant complications.

Intrauterine device displacement with embedment of both arms occurs infrequently therefore still confers a great diagnostic and management challenges. Hysteroscopic evaluation and management may be the best option available when this condition is suspected..

Intrauterine device, displacement, embedment, Transvaginal sonogrphy, Hysteroscopy.

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VOLUME 02 ISSUE 01 OCTOBER 2019