{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T18:40:01Z","timestamp":1770316801238,"version":"3.49.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Retained intrauterine devices (IUDs) after menopause are common in China, yet their complications may be clinically silent. Uterine atrophy and rigid open-frame designs can permit gradual transmural erosion, leading to seemingly routine removal requests that conceal high-risk extrauterine involvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 54-year-old asymptomatic postmenopausal woman presented for elective IUD removal. Transvaginal ultrasound suggested deep myometrial embedment with suspected serosal extension. During hysteroscopy, the device could be grasped but exhibited extreme traction resistance, raising concern for transmural perforation; the procedure was immediately converted to laparoscopy. Laparoscopy revealed a rare dual-site extrauterine embedment: one arm perforated the posterior uterine wall and was embedded in the pelvic peritoneum adjacent to the left ureter, while the contralateral arm traversed the fundus and was completely impacted within the right tubal isthmus. Right therapeutic salpingectomy and opportunistic contralateral salpingectomy were performed. Under laparoscopic visualization, the IUD was then safely retrieved through the uterine cavity with hysteroscopic guidance. The postoperative course was uneventful.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case illustrates that postmenopausal IUD retention can culminate in severe, multi-organ-adjacent perforation without symptoms, and that ultrasound may underestimate the extent of extrauterine involvement. In hysteroscopic IUD removal, \u201cextreme traction resistance\u201d should be treated as an intraoperative red-flag prompting immediate cessation and conversion to laparoscopy. A combined hysteroscopic-laparoscopic strategy enables controlled dissection, organ protection, particularly the ureter and tube, and complete retrieval with minimal uterine trauma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1772440","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:44:27Z","timestamp":1770273867000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["An asymptomatic postmenopausal uterine perforation with bilateral embedment by a V-shaped intrauterine device: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Xilian","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University","place":["Hangzhou, China"]},{"name":"Department of Obstetrics and Gynecology, Shanghang County Hospital","place":["Longyan, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruxi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianye","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianwei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaxi","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1486745","DOI":"10.3389\/fmed.2024.1486745","article-title":"Removal of an incarcerated intrauterine device reaching the serosal surface of the uterus by hysteroscopy alone: a case report","volume":"11","author":"Y","year":"2025","journal-title":"Front Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1097\/GME.0000000000002022","article-title":"Risk factors for delayed intrauterine device removal among menopausal women in rural China","volume":"29","author":"Zong","year":"2022","journal-title":"Menopause"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2658","DOI":"10.1093\/humrep\/des246","article-title":"Intrauterine 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