{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:43:08Z","timestamp":1784310188824,"version":"3.55.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T00:00:00Z","timestamp":1736208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>An intrauterine device (IUD) is a widely used long-term contraceptive device for family planning. However, the IUD can lead to various complications. Severe complications and remedial measures caused by IUDs have been reported in the literature; however, detailed surgical approaches for safely removing the IUD within the minimum surgical range have rarely been described especially in postmenopausal women. Therefore, this article aims to share our surgical experience in removing an IUD that had reached the serosal surface of the uterus using hysteroscopy alone after menopause to provide new clinical ideas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case introduction<\/jats:title><jats:p>We report the case of a 63-year-old Chinese patient with a 12-year history of menopause. She had an IUD placed after an abortion more than 30\u202fyears ago. She came to the hospital because of occasional a small amount of unprovoked vaginal bleeding, the preoperative examination suggested an embedded IUD that appeared to have reached the serosal surface of the uterus. The IUD was not visible during hysteroscopic surgery because of uterine adhesions. Microscissors were employed to cut along the white adhesion band, revealing a faintly visible metal wire. We successfully removed the IUD using hysteroscopy only. The patient has recovered well after surgery and has been in good health for more than 5\u202fmonths, with no complaints of abdominal pain or vaginal bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case suggests that hysteroscopic exploration can be performed in patients whose preoperative examination indicates that the IUD has reached or protrudes from the serosal surface of the uterus. If necessary, laparoscopic or open surgery can be performed. For patients whose IUD is not visible in the uterine cavity, preoperative imaging can help assess the thickness of the uterine myometrium and the distance to the serosal surface. Intraoperatively, scissors can cut through tissue or adhesions, and instruments can measure the separation distance or visualize the device within the adhesions. In addition, it is crucial to know the patient\u2019s expectations, assess the pros and cons, and discontinue the procedure if necessary.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1486745","type":"journal-article","created":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T07:35:39Z","timestamp":1736235339000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Removal of an incarcerated intrauterine device reaching the serosal surface of the uterus by hysteroscopy alone: a case report"],"prefix":"10.3389","volume":"11","author":[{"given":"Min","family":"You","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin-Fang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai-Qian","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,7]]},"reference":[{"key":"ref1","volume-title":"Chinese obstetrics and Gynaecology","author":"Zeyi","year":"2008"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2658","DOI":"10.1093\/humrep\/des246","article-title":"Intrauterine contraception: incidence and factors associated with uterine perforation-a population based study","volume":"27","author":"Kaislasuo","year":"2012","journal-title":"Hum Reprod"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.contraception.2015.01.007","article-title":"Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European active surveillance study on intrauterine devices","volume":"91","author":"Heinemann","year":"2015","journal-title":"Contraception"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.ejogrb.2011.07.003","article-title":"Minimally invasive approach to cases of lost intra-uterine device: a 7-year experience","volume":"159","author":"Cetinkaya","year":"2011","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1016\/j.jmig.2013.12.123","article-title":"Perforated intraperitoneal intrauterine contracep tive devices: diagnosis, management, and clinical outcomes","volume":"21","author":"Kho","year":"2014","journal-title":"J Minim Invasive Gynecol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e14117","DOI":"10.1097\/MD.0000000000014117","article-title":"Chronic nodules of sigmoid perforation caused by incarcerated intrauterine contraception device","volume":"98","author":"Huang","year":"2019","journal-title":"Medicine"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1093\/humupd\/dmn003","article-title":"Intrauterine devices and intrauterine systems","volume":"14","year":"2008","journal-title":"Hum Reprod Update"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.yjmcc.2015.06.006","article-title":"Building a better infarct: modulation of collagen cross-linking to increase infarct stiffness and reduce left ventricular dilation post-myocardial infarction","volume":"85","author":"Yabluchanskiy","year":"2015","journal-title":"Mol Cell Cardiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1080\/ejc.8.3.150.155","article-title":"Analysis of risk factors associated with uterine perforation by intrauterine devices","volume":"8","author":"Caliskan","year":"2003","journal-title":"Eur J Contracept Reprod Health Care"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1097\/GME.0000000000002191","article-title":"Risk factors for intrauterine device embedment in postmenopausal women: an analysis of 731 participants undergoing hysteroscopy","volume":"30","author":"Jiang","year":"2023","journal-title":"Menopause"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"19","DOI":"10.2147\/OAJC.S85546","article-title":"Intrauterine devices and risk of uterine perforation: current perspectives","volume":"7","author":"Rowlands","year":"2016","journal-title":"Open Access J Contracept"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/j.contraception.2012.08.005","article-title":"Treatment of unscheduled bleeding in women using extended-or continuous-use combined hormonal contraception: a systematic review","volume":"87","author":"Godfrey","year":"2013","journal-title":"Contraception"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"00026-0","DOI":"10.1016\/j.ajog.2021.01.003","article-title":"Design of the Association of uterine perforation and expulsion of intrauterine device study: a multisite retrospective cohort study","author":"Anthony","year":"2021","journal-title":"Am J Obstet Gynecol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1080\/13625187.2021.1874337","article-title":"Dislocated intrauterine devices: clinical presentations, diagnosis and management","volume":"26","author":"Tabatabaei","year":"2021","journal-title":"Eur J Contracept Reprod Health Care"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1111\/jog.12620","article-title":"Evaluation of predisposing factors, diagnostic and treatment methods in patients with translocation of intrauterine devices","volume":"41","author":"Agacayak","year":"2015","journal-title":"J Obstet Gynaecol Res"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1186\/s12905-024-03298-3","article-title":"Risk factors of uterine perforation when using contraceptive intrauterine devices","volume":"24","author":"Tabatabaei","year":"2024","journal-title":"BMC Womens Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1093\/humrep\/det074","article-title":"Uterine perforation caused by intrauterine devices: clinical course and treatment","volume":"28","author":"Kaislasuo","year":"2013","journal-title":"Hum Reprod"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1093\/humrep\/dev102","article-title":"Menstrual characteristics and ultrasonographic uterine cavity measurements predict bleeding and pain in nulligravid women using intrauterine contraception","volume":"30","author":"Kaislasuo","year":"2015","journal-title":"Hum Reprod"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1007\/s00404-024-07457-7","article-title":"The contradictive findings between ultrasound, hysteroscopy and cytokines in women with nonhormonal IUDs suffering from menorrhagia: a prospective study","volume":"309","author":"Watad","year":"2024","journal-title":"Arch Gynecol Obstet"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"4233","DOI":"10.3390\/jcm13144233","article-title":"Intrauterine contraceptive device migrated in the urinary tract: case report and extensive literature review","volume":"13","author":"Varlas","year":"2024","journal-title":"J Clin Med"},{"key":"ref21","first-page":"131","article-title":"An intrauterine contraceptive device: where did we find it after 29 years of insertion? A case report","volume":"67","author":"Ples","year":"2017","journal-title":"J Pak Med Assoc"},{"key":"ref22","first-page":"649","article-title":"Technical guidelines for postmenopausal intrauterine device removal","volume":"54","year":"2019","journal-title":"Chinese J Obstetrics Gynaecol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2541","DOI":"10.3390\/cancers16142541","article-title":"Management for Cervical Cancer Patients: a comparison of the guidelines from the international scientific societies (ESGO-NCCN-ASCO-AIOM-FIGO-BGCS-SEOM-ESMO-JSGO)","volume":"16","author":"Restaino","year":"2024","journal-title":"Cancers"},{"key":"ref24","first-page":"e2024038","article-title":"Discovery of a missing intrauterine system in the peritoneal cavity during cervical cancer surgery: a case report","volume":"95","author":"Restaino","year":"2024","journal-title":"Acta Biomed"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1016\/j.jmig.2019.03.012","article-title":"Emergent laparoscopic removal of a perforating intrauterine device during pregnancy under regional anesthesia","volume":"26","author":"Giampaolino","year":"2019","journal-title":"J Minim Invasive Gynecol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e08751","DOI":"10.1016\/j.heliyon.2022.e08751","article-title":"Intrauterine contraceptive device rupture. Follow-up of a retrospective cohort and clinical protocol. RUDIUS study","volume":"8","author":"C\u00e1novas","year":"2022","journal-title":"Heliyon"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1486745\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T07:35:42Z","timestamp":1736235342000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1486745\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,7]]},"references-count":26,"alternative-id":["10.3389\/fmed.2024.1486745"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1486745","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,7]]},"article-number":"1486745"}}