Contraceptive ring-induced intestinal obstruction

A post-menopausal 59-year-old female presented with abdominal pain for 1 day. Relevant past medical history included two children born via spontaneous vaginal delivery >30 years ago and two times insertion of intrauterine contraceptive ring >20 years ago. On examination, she had umbilical and right-sided abdominal tenderness, and rebound tenderness with guarding in the right iliac fossa. On auscultation, hyperacoustic bowel sounds were present. Abdominal X-rays showed two areas of small bowel gas–fluid levels and two contraceptive rings were apparent on the X-ray—one in the middle of the pelvic cavity while the other was located in the right lower quadrant (Figure 1A, arrow). She was kept nil-by-mouth, commenced on antibiotics and gastrointestinal decompression. After 1 day, her symptoms did not improve and an abdominal computer tomography (CT) scan was performed, which showed numerous loops of dilated small bowel, and one contraceptive ring located inside the affected small bowel (Figure 1B, arrow). In light of this, the patient underwent a laparotomy that revealed two uterine rings—one still inside in the uterus and the other …