Vol. 67, No. 1, January 2017 131 Abstract Intrauterine contraceptive devices (IUCD) are one of the most popular and modern means of contraception used worldwide. Some described complications include perforation, infection and ectopic pregnancy. Herein we report an uncommon complication of IUCD: perforation and migration in the terminal ileum. A 56-year-old woman presented to our institution with lower abdominal pain. She had had an IUCD placed 29 years previously. The IUCD was inserted in unsafe conditions since then it was prohibited in Romanian to use any contraception device or pills. The IUCD was placed clandestinely in uncertain condition and could never be checked after. An exploratory laparotomy evidenced the presence of IUCD migrated to terminal ileum. A 56-year-old woman presented to our institution with lower abdominal pain. She had had an IUCD placed 29 years previously. The IUCD was inserted in unsafe conditions since at that time it was prohibited in Romania to use any contraceptive device or pills. The IUCD was placed clandestinely in uncertain condition and a follow- up could not have been performed. An exploratory laparotomy evidenced the presence of IUCD which had migrated to the terminal ileum. ThiscasedemonstratesanunusuallocalisationofanIUCD in the ileum, but the particularity is that we found it after 29 years of its insertion and and the patient had no specific gastrointestinal symptoms. Keywords: Intrauterine device, Ileum, Contraception, Case report. Introduction The intrauterine contraceptive device (IUCD) is considered as a safe and effective contraceptive method, used in developed and developing countries, and reported to be used by 1.8% of the United States population. 1 Uterus perforation from 0.05 and 13 per 1000 insertions have been reported earlier. 2 Herein we report a case of uncommon complication of IUCD: perforation and migration in the terminal ileum. Case Report A 56-year-old post-menopausal woman presented in our clinicinOctober2013withpainintherightiliacfossa.She reported the onset of the pain as an intermittent discomfort for two months, especially in the right iliac fossa. She reported no other symptoms such as vaginal bleeding, nausea, weakness, dizziness, vomiting or fever. Her medical and surgical history consisted of open appendectomy in childhood and two vaginal deliveries. She report that an IUCD was inserted when she was 27 yearsold.Afterfouryears,shewantedtoremovetheIUCD but the cervical thread was not apparent at the os cervix, and the device was not found during this procedure. One year later, she had her second spontaneus delivery and was informed that the device was lost and no other investigatigation was performed. Examination on presentation revealed a haemodynamically stable patient with no signs of fever, jaundice or dehydration, but the patient was in distress and in pain. Her abdomen was soft and she had complainedofmarkedrightiliacfossapain,buttherewas no tenderness. Vaginal speculum and rectal examination revealed no abnormality. The ultrasound scan report showed a normal sized, anteverted uterus with no visualisation of IUCD. There was a sonolucent cystic mass neartheiliacveselswithanecodensemassinside.Theleft adnexa presented normal sonographic features. There was no fluid in the pouch of Douglas. Computer tomographic scan (CT scan) examination revealed a fractured IUCD, which had migrated, presumably in the right fallopian tube with local adhesionsincludingapartofthesmallbowel.Penetration of the small bowel could not be observed (Figure-1). Considering the pain and the findings revealed by the CASE REPORT An intrauterine contraceptive device: where did we find it after 29 years of insertion? A case report Liana Ples, 1 Romina Marina Sima, 2 Cristina Moisei, 3 Cringu Antoniu Ionescu 4 1 Department of Obstetrics and Gynecology, Saint John Hospital, UMF Carol Davila Bucharest, 2,3 Department of Obstetrics and Gynecology, Saint John Hospital, Bucharest, 4 Department of Obstetrics and Gynecology, UMF Carol Davila Bucharest, Saint Pantelimon Hospital, Romania. Correspondence: Liana Ples. Email: liaples@yahoo.com