Title: Migrated Intra-Uterine Device to Infra-umbilical skin: A rare Case Report
Version: 1 Date: 16 Oct 2024
Reviewer:  Yuquan Chen
Reviewer's report:
The case report titled "Migrated Intrauterine Device to Infraumbilical Skin: A Rare Case Report"
presents an interesting and unusual case of IUD migration that was successfully managed
without complications. While the authors have effectively highlighted the rarity of this condition
and documented the clinical scenario, the manuscript requires substantial improvements to
enhance clarity, depth, and readability.
Firstly, the introduction section lacks detailed background information on the mechanisms and
risk factors that lead to IUD migration, which would provide a better context for understanding
the case. Expanding on anatomical factors and clinical practices that predispose patients to this
rare complication would be beneficial. Furthermore, certain aspects of the case presentation are
ambiguous. For instance, the report mentions that the IUD was inserted two years ago, but it
does not explain why the patient did not follow up after the procedure. More information on the
patient’s medical history, especially regarding the lack of follow-up visits or attempts to palpate
the IUD strings, could provide insight into the delayed diagnosis.
The description of diagnostic imaging is also insufficient. While the manuscript notes an
ultrasound showing an empty uterus, it fails to provide adequate details on how the exact
location of the migrated IUD was confirmed. Adding descriptions of the diagnostic process,
including any imaging modalities used and their findings, would greatly enhance the clarity
of the case report. Additionally, the discussion section does not thoroughly explore alternative
management strategies for migrated IUDs. Comparing the approach used in this case (removal
via ring forceps) with other documented methods, such as laparoscopic removal, could offer
readers a more comprehensive understanding, particularly for cases where the device migrates
to subcutaneous tissue.
The literature review is notably brief and misses the opportunity to contextualize the case with
other documented instances of IUD migration. Expanding this section to include more references
to similar cases, and discussing how this case aligns with or differs from those reports, would
provide a deeper understanding of the incidence and possible preventive measures for IUD
migration. Moreover, the report lacks sufficient information on patient follow-up after the IUD
removal. Details on subsequent symptoms or complications would offer a more complete clinical
picture, emphasizing the importance of regular post-procedure check-ups.
The manuscript also suffers from inconsistencies in writing and terminology, with several
grammatical errors that disrupt the text's flow. Terms like "infra umbilical" should be
consistently hyphenated ("infra-umbilical") throughout the document. Furthermore, the
descriptions of symptoms and clinical findings could be made more concise, improving overall
readability. Lastly, although the authors state that informed consent was obtained, the manuscript
does not clearly indicate the ethical approval process for the case report. Providing more details
on ethical considerations, including specific approval from the ethics board and any guidelines
followed to ensure patient confidentiality, would help address this gap.
In summary, while the case is intriguing and well-documented, the manuscript needs major
revisions to address these specific issues and enhance its quality.