In March 2014, a woman in China received an intrauterine device, or IUD, for the fourth time. A month later, she returned to care with abdominal pain, swelling in her right leg, and difficulty moving. An ultrasound did not show the device inside her uterus and found no abnormality in the uterus or nearby structures. After a day of rest, her symptoms improved.
What happened to the IUD was never determined. Nine years later, when she was 38, she was hospitalized after a week of persistent lower abdominal pain. A CT scan revealed metal inside her bladder.
Doctors from Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital and Gongshan People’s Hospital described the case in Frontiers in Surgery on July 21, 2026. They said the long delay was likely linked to an initial misreading of the ultrasound results.
A History of Four IUD Insertions
According to the report, all four devices had been inserted at the same local maternal and child health hospital. Two IUDs placed in 2012 and a copper T inserted in 2013 were each expelled within about two months. The fourth device, a copper IUD known as MYCu, was placed in March 2014. Medical records did not show how or when it left the uterus.
The patient later had four pregnancies, including full-term deliveries in 2017 and 2023. During that time, the missing device’s actual location remained unknown.
Few Symptoms Despite Bladder Perforation
When she was admitted to the hospital nine years after the insertion, she reported no urinary frequency, urgency, pain, fever, chills, or blood in her urine. Doctors found mild tenderness in her lower abdomen, while her blood count and inflammation marker were normal.
A CT scan with three-dimensional reconstruction showed metallic densities in the bladder, with the largest piece lodged in the bladder wall. A color Doppler ultrasound also detected a bright structure measuring 15 by 6 millimeters inside the bladder.
Because the hospital did not have laparoscopic equipment available, surgeons performed open abdominal surgery. They found dense adhesions connecting the omentum, a fatty layer of tissue in the abdomen, to the bladder. The IUD was still intact. One arm was embedded in the bladder’s muscle layer, while the other had passed through the full thickness of the bladder wall and protruded into the bladder cavity.
The surgeons removed the device and closed the bladder in two layers. The patient was discharged five days later. A follow-up ultrasound in February 2024 showed a normal bladder, and the authors reported that she had remained free of urinary symptoms.
How an IUD Can Move Outside the Uterus
The authors said the most likely explanation was a “procedural error during insertion.” The patient had no history of uterine perforation, and none of the insertions occurred while she was breastfeeding after childbirth, a period associated with a higher risk of perforation.
IUD perforation is uncommon. In a European study of more than 61,000 IUD users, the rate was 1.4 per 1,000 insertions for hormonal devices and 1.1 per 1,000 insertions for copper devices. Breastfeeding at the time of insertion increased the relative risk about sixfold, though the absolute risk remained low. No perforations in that study led to serious illness or organ injury.
Ultrasound is commonly used to check IUD placement, but it has limitations. In published cases reviewed by the authors, color Doppler ultrasound missed displaced devices at rates as high as 28%, while CT scans reliably identified their location. In two earlier bladder cases, Doppler ultrasound failed to find IUDs that CT scans located nine and 11 years after insertion. In this patient’s case, the absence of the device in the uterus did not mean it had left her body.
The authors reviewed 30 published studies involving IUDs found in the bladder. Urinary tract infections and lower abdominal or pelvic pain were the most common symptoms, though a small number of patients had no symptoms. Displacement was detected anywhere from one to 312 months after insertion, with one peak during the first year and another after five years. Copper T and MYCu devices were the types most often reported, which the authors attributed to their widespread use and to rigid side arms that may put pressure on the uterine wall. The study was funded by public science and health programs in Shanghai’s Pudong New Area, and the authors declared no commercial conflicts.
What IUD Users Should Know
IUDs remain among the most effective and widely used forms of long-acting contraception, and complications like this are rare. This report describes a single patient, one device type, and treatment at a hospital without laparoscopic equipment, so it cannot establish how often similar cases occur elsewhere, including in the United States.
The case is consistent with another published report involving a 40-year-old woman whose copper IUD was presumed expelled after it was not visible on ultrasound. About a year later, she received a hormonal IUD. Later imaging showed that the first device had migrated outside the uterus, and she required abdominal surgery to remove it. The authors of that report recommended confirmatory imaging whenever an IUD cannot be seen.
Current clinical guidance follows a similar approach. A July 2026 algorithm from the Reproductive Health Access Project for IUDs with missing strings begins with ultrasound, moves to an abdominal X-ray if the device is not visible, and refers patients to a gynecologist for surgery when the device is located outside the uterus.
For IUD users, the practical advice is straightforward. Anyone who cannot feel their IUD strings or who develops new pelvic pain, urinary symptoms, or other unexplained problems after insertion should contact the clinician who placed the device. Imaging can help confirm where the IUD is located.
Key Questions Answered
What happened to the woman’s IUD?
A copper IUD inserted in March 2014 could not be accounted for. Nine years later, a CT scan showed that it had perforated into her bladder, with one arm embedded in the bladder muscle and the other extending into the bladder.
Did she have urinary symptoms?
No. She reported no urinary frequency, urgency, pain, or blood in her urine. She did have lower abdominal pain in 2014 and again when the device was discovered.
How was the IUD removed?
Surgeons performed open abdominal surgery because laparoscopic equipment was unavailable. They removed the intact device, repaired the bladder, and discharged her five days later.
How common is IUD perforation?
A large European study found about 1.1 to 1.4 perforations per 1,000 insertions. Migration into the bladder is much rarer.
What symptoms should IUD users watch for?
Missing strings, new pelvic pain, or urinary symptoms after insertion are reasons to contact a clinician. Imaging can confirm the device’s location.