In March 2014, a woman in China had an IUD placed for the fourth time. A month later, she was back with abdominal pain, a swollen right leg, and trouble moving around. An ultrasound found no device in her uterus and nothing abnormal in her uterus or the structures beside it, and after a day of rest, she felt better.
Where the IUD had gone was never established. Nine years later, at 38, she was admitted with a week of persistent lower abdominal pain. A CT scan showed metal inside her bladder.
Gynecologists at 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 attribute the nine-year delay to an initial misinterpretation of her ultrasound.
Four Insertions and One Device Nobody Accounted For
The report lays out her history in detail. All four devices were placed at the same local maternal and child health hospital. Two IUDs placed in 2012 and a copper T placed in 2013 were each expelled within about two months. The fourth, a copper device of a type called MYCu, was inserted in March 2014. How and when it left her uterus is listed as unknown.
Her records show four more pregnancies after that insertion, including full-term deliveries in 2017 and 2023, all while the device’s true location went unrecognized.
No Urinary Symptoms, Even with a Device Through the Bladder Wall
When she was finally admitted, she reported no urinary frequency, urgency, or pain, and no fever, chills, or blood in her urine. She had mild tenderness in the lower abdomen, and her blood count and inflammation marker were normal.
CT with three-dimensional reconstruction showed metallic densities in the bladder, with the largest piece embedded in the bladder wall. A color Doppler ultrasound found a bright structure measuring 15 by 6 millimeters inside the bladder.
Because the hospital had no laparoscopic equipment on site, surgeons performed open abdominal surgery. They found dense adhesions binding the omentum, a fatty apron of tissue in the abdomen, to the bladder. The IUD was intact. One arm was lodged in the bladder’s muscle layer, and the other had passed through the full thickness of the wall into the bladder’s interior.
Surgeons removed the device and closed the bladder in two layers. She was discharged five days later, and a follow-up ultrasound in February 2024 showed a normal bladder. She has remained free of urinary symptoms, the authors report.
How an IUD Ends Up Outside the Uterus
The authors say the most plausible explanation is “procedural error during insertion.” She had no prior uterine perforation, and none of her insertions took place while she was breastfeeding after a birth, a period linked to higher perforation risk.
Perforation is uncommon. In a European study of more than 61,000 IUD users, it occurred in 1.4 per 1,000 insertions of hormonal devices and 1.1 per 1,000 insertions of copper devices. Breastfeeding at the time of insertion raised the relative risk about sixfold, though the absolute risk stayed low, and no perforation in that study led to serious illness or organ injury.
Ultrasound, the usual follow-up tool, has limits. In the published cases the authors reviewed, color Doppler ultrasound had reported missed-diagnosis rates as high as 28% for displaced devices, while CT reliably located them. In two earlier bladder cases, for example, Doppler ultrasound failed to find devices that CT located 9 and 11 years after insertion. In this woman’s case, an empty uterus on ultrasound did not mean the device was gone.
The authors reviewed 30 published studies of IUDs found in the bladder. Urinary tract infections and lower abdominal or pelvic pain were the most commonly reported symptoms, which usually lead to earlier diagnosis, though a small number of patients had no symptoms. Displacement turned up anywhere from 1 to 312 months after insertion, with one peak in the first year and another after five years. Copper T and MYCu devices were the types most often reported, which the authors attribute to how widely those devices are used and to rigid side arms that may stress 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 Can Take From One Unusual Case
IUDs remain among the most effective and widely used long-acting contraceptives, and complications like this one are rare. This report describes one woman, one device type, and care delivered in a setting without laparoscopic equipment, so it cannot show how often such cases occur elsewhere, including in the United States.
It does echo a warning from another report. Doctors affiliated with Aga Khan University described a 40-year-old woman whose copper IUD was presumed expelled after it did not appear on ultrasound. About a year later, she received a hormonal IUD. Imaging eventually showed the first device had migrated outside the uterus, and she needed abdominal surgery to retrieve it. The authors urged confirmatory imaging whenever an IUD cannot be seen.
That approach is built into current clinical tools. A July 2026 algorithm from the Reproductive Health Access Project for IUDs whose strings cannot be seen starts 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 outside the uterus.
For IUD users, the practical points are straightforward. Anyone who cannot find their IUD strings, or who develops new pelvic pain, urinary symptoms, or other unexplained problems after an insertion, should contact the clinician who placed it. Imaging can confirm where the device actually is.
Key Questions Answered
What happened to the woman’s IUD?
A copper IUD inserted in March 2014 went unaccounted for. Nine years later, CT showed it had perforated into her bladder, with one arm in the bladder muscle and the other inside the bladder.
Did she have urinary symptoms?
No. She denied urinary frequency, urgency, pain, and blood in the urine. She did have lower abdominal pain, both in 2014 and when she was diagnosed.
How was it removed?
Surgeons performed open abdominal surgery because laparoscopic equipment was not available, removed the intact device, and repaired the bladder. She went home 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 far rarer.
What should IUD users watch for?
Missing strings, new pelvic pain, or urinary symptoms after insertion are reasons to contact a clinician. Imaging can confirm where the device is.
