Aim: To highlight the shortcomings of obstetric care in Indonesia. Background: Wandering intrauterine devices (IUDs) is often asymptomatic, but it may also generate significant complaints. While preventable, negligence and human errors could worsen patient outcomes. Management of such cases is usually straightforward but could be hampered in low-resource settings. Case description: A 44-year-old para 2 abortus 2 (P2A2) woman with multiple wandering IUDs presented with acute urinary retention and a radiating left lower abdominal pain. A Lippes loop was inserted 19 years ago, which mistakenly was assumed to have been expelled during a miscarriage. A copper IUD was inserted 8 years ago, but she underwent no follow-ups. Abdominal radiograph revealed a copper IUD and another radiopaque foreign body. The copper IUD was successfully removed. Ultrasound revealed no intrauterine Lippes loop. Lack of on-site obstetricians/gynecologists led to her referral. Exploratory laparotomy was performed. The loop was in the rectovaginal pouch embedded to the posterior uterine wall with significant adhesions. An uneventful recovery ensued. Conclusion: The lack of on-site specialists and low-resource setting presented unique challenges to this case and underlines the importance of emergency physicians being adept at point-of-care ultrasound (POCUS) in specialist poor low-resource settings. Clinical significance: Emergency physicians should receive additional training, e.g., ultrasound, to better provide obstetric care in low-resource and specialist poor settings.
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