A 31-year-old woman had a levonorgestrel-releasing intrauterine system (IUS) inserted by her GP 3 weeks ago. She was presented to the emergency department with abdominal pain, and on examination the threads were not visible and ultrasound scan suggested the IUS was misplaced in the right uterine cornu. An appointment was made for hysteroscopic resection but she was presented again in the interim with further pain. Examination: The abdomen is not distended and is soft. There is generalized lower abdominal tenderness. The threads cannot be visualized on speculum examination. Investigations: Transvaginal ultrasound report: the uterus is anteverted and of normal size.
The endometrium is regular and measures 11 mm. An IUS is not visible. Both ovaries appear normal in size and morphology. Abdominal X-ray is shown. What would be the diagnosis for the case? How should the patient be further…
