The "Lost" and "Found" IUD: a case of concurrent intrauterine and intraperitoneal devices with delayed recognition.

BACKGROUND: Intrauterine devices (IUDs) are widely used and highly effective long-acting reversible contraceptives; however, rare complications such as uterine perforation and device migration may occur. A critical and preventable clinical pitfall is the misinterpretation of missing retrieval strings as spontaneous expulsion, which may lead to reinsertion without imaging confirmation, resulting in dual IUD retention, delayed diagnosis, and potential complications including visceral organ injury. CASE PRESENTATION: We report a case of a 45-year-old woman with an incidental finding of dual IUDs. Imaging revealed one device within the uterine cavity and a second device that had migrated intraperitoneally. Laparoscopic retrieval was successful, and the postoperative course was uneventful. CONCLUSION: This case highlights the importance of the systematic evaluation of "missing" IUD strings, including a pelvic examination and radiographic confirmation prior to reinsertion to prevent dual-device scenarios and associated morbidity. Early recognition, prompt imaging, and minimally invasive surgical management are essential for optimal outcomes.