The extrauterine migration of an intrauterine device (IUD) is a known complication, either as a result of IUD expulsion or uterine perforation. Patients may present very differently; with signs of perforation or infection and have a very tender pelvic on abdominal examination or they may have a more subtle presentation and have only very mild tenderness on examination.

Objective: This case report describes two different presentations of extrauterine migration of IUD due to probable perforation.

Case Report: This is a case report of two uncommon but potentially dangerous outcomes of IUD placement and use. One case was an incidental finding at time of removal and the other case presents with lower abdominal pain. Both had subtle presentation of a potentially life-threatening diagnosis.

Conclusion: This article presents the two cases, discusses the incidence, likely causes, predisposing factors, diagnostic modalities and the treatment of this diagnosis.