Incomplete removal of an intrauterine system

A 38-year-old woman, gravida 4 para 1, had a levonorgestrel intrauterine system (LNG IUS) inserted just after a third induced abortion. Thirteen months later she insisted on the IUS being removed because of amenorrhea. Ultrasound examination showed that it was normally located. A junior doctor was asked to remove it. On insertion of the speculum, the threads were clearly visible. The threads were gently pulled and the device was removed easily. The doctor thought it was intact. However, the patient still suffered from amenorrhea. Ultrasound examination appeared normal, so hysteroscopy was arranged. At hysteroscopy, moderate intrauterine adhesions were found. After hysteroscopic electrosurgery to divide the adhesions, the retained outer sleeve of the IUS was seen with fibrous tissue wrapped over its surface. It was grasped with forceps via the hysteroscope …