Pneumoperitoneum caused by perforation of pyometra associated with a lost intrauterine device and perforated malignancy of the sigmoid colon.

Intrauterine devices (IUDs) have been plagued by many early and late complications, including uterine perforation and subsequent migration into adjacent structures. Perforation of the uterus by an IUD is a serious complication occurring in approximately 1 of 350 to 1 of 2,500 insertions. It is more common among older women with “lost” IUDs. This case illustrates that unusual phenomenon that a lost IUD can penetrate into the omentum. We herein report a case of acute peritonitis and pneumoperitoneum with perforation of the uterus associated with a lost IUD and perforation of a malignancy of the sigmoid colon. A 68-year-old woman, Gravida 4, Para 4, presented to the emergency department with a 2-hour history of sudden, diffuse lower abdominal pain. Physical examination revealed an acutely ill-appearing patient with unstable vital signs, including a temperature of 37.8 C. The patient’s abdomen was distended with marked rebounding tenderness and varying tympanic sound on percussion. Bowel sounds were sparse. Her family disclosed that the patient had received an insertion of a loop IUD at 30 years previously and had complaints of pelvic pain, difficulty defecating, and mucus and blood in the stool for the past 6 months. Laboratory studies revealed a white blood cell count of 5,400/mL with a neutrophilic shift to the left (segmented: 84%; normal: 55e71%), hemoglobin of 6.8 g/dL (normal: 12e16 g/dL), and a C-reactive protein level of 144 mg/L (normal: <5 mg/L). Tests of liver and renal functions were normal, except for an alkaline phosphorylase level of 403 U/L. Abdominal ultrasonography showed massive ascites and a plain X-ray of the abdomen revealed pneumoperitoneum