Laparoscopic removal of an eroding Mirena coil through the sigmoid colon.

To the Editor—I read with interest the recently published article by Hussain et al,1 which reported a case of translocated intrauterine device (IUD) removed laparoscopically. I am most curious to know the meaning of “inconclusive X-rays” as stated by the authors. As Mirena is radiopaque, it can either be seen or not seen on X-rays, rather than inconclusive. For the purpose of illustration, I have included an X-ray of a 33-year-old woman who had a partially embedded Mirena in the uterine fundus (Fig). Interestingly, on reading an X-ray for a lost IUD, one really has to look for it to identify its presence. Further, in this reported case, if the X-rays were indeed inconclusive, on what basis did the authors decide that the IUD was expelled, without considering other imagings such as computed tomography (CT)? If the IUD was translocated close to the bowel, CT could also help to determine the presence and the degree of bowel penetration,2-4 so that preoperative counselling and preparation could be provided before proceeding with laparoscopy. The inference of “inconclusive X-rays” should have been pursued further, to avoid the surprise in finding at the first laparoscopy and the need for a second laparoscopy to remove the IUD.