Amenorrhoea despite displaced levonorgestrel intra-uterine system.

A 29-year-old woman presented to the gynecology outpatient clinic with abdominal discomfort following the insertion of a levonorgestrel intrauterine system (LNG-IUS). It was noted that although the patient remained amenorrheic since the insertion, there was a persistent left iliac fossa discomfort, which was constant in nature and not made worse by intercourse. On examination, there was a vague tenderness in the left iliac fossa, and a transvaginal ultrasound scan showed bright echoes outside the uterus suggestive of an extrauterine IUS. Thus, arrangements were made for an admission for hysteroscopy and laparoscopy, proceeding to laparotomy if required. Following the procedures, the patient reported disappearance of the discomfort, although the LNG-IUS had not yet been retrieved. X-ray revealed the device lying high in the abdomen and laparoscopy was conducted. The LNG-IUS itself was buried, but was easily retrieved with gentle counteraction on the omentum through a 5 mm laparoscopy portal. Overall, this case emphasizes the importance of an X-ray as well as an ultrasound investigation in such cases.