Perforating bladder injury due to an intra uterine device (IUD) is a very rare injury. This is a serious complication, very rarely when an IUD perforating the bladder. We report a case of IUD migration and detection after a long period of time to analyze the possible causes and solutions for this complication.

Case report

A 57-year-old woman had symptoms of dysuria and pelvic pain for 1 year. The patient had an IUD inserted at the age of 22 after giving birth to 2 children. The patient did not go for a check-up of the IUD's position. At the age of 35, the patient began to experience pelvic pain and hematuria. According to the patient, the IUD was removed at 40 years old, but it were difficulties and moderate bleeding. Subsequently, the pain was reduced, but remained. At the age of 56, the patient went to a psychiatrist and was diagnosed with neurasthenia, and was given Tofisopam, Sertraline, Etifoxin, Sulpirid, Amitriptyline. Afterward, the patient overdosed for taking a doubled amount as described, and was admitted to ICU for 1 week of treatment and had a urinary catheter inserted. After discharge, the patient had symptoms of dysuria, so she came to visit us. At the first examination, no abnormalities were detected as the catheter was previously placed under ultrasound. In addition, we performed cystometric test, and the results indicated neurogenic bladder with the estimation residual urine volume of 150ml and maximum bladder volume of 159ml. Then the patient was instructed to perfom clean intermettent catheterisation. However, at the next follow-up examination, the patient still had dull bladder pain and a lesion suspected of bladder tumor was detected under ultrasound. The patient then undergone an endoscopy which revealed a columnar lesion connecting the anterior and posterior bladder walls, while the mucosa was smooth. CT urography of showed a lesion connecting the anterior and posterior bladder walls, the bladder muscle layer was no longer visible at the two ends of the lesion, only a density like fat was seen. We decided to transurethral resection of a bladder tumor. The following pathological report stated the collected tissue sample was fatty tissue. After surgery, the patient no longer endured pain, urinated well, cystoscopy only showed scars, and the patient was also completely off the neurasthenic drugs.

Patients with IUD should be suggested to check the device regularly. For patients with IUD combined with lower urinary tract symptoms, it is necessary to be aware of whether IUD perforation affects the bladder.