Uterine Perforation Due to IUD Migration: A Rare Cause of Pneumoperitoneum in an Elderly Female

Background: Intrauterine devices (IUDs) are widely used as a safe and effective form of long-term contraception. Although complications are uncommon, IUD migration and uterine perforation are rare but serious adverse events. These complications can lead to acute abdominal emergencies, including pneumoperitoneum and peritonitis, which may mimic gastrointestinal perforation.Case Presentation: We report the case of a 71-year-old woman with a history of type 2 diabetes mellitus and a left lower limb fracture, who presented with generalized abdominal pain, nausea, and vomiting. CT imaging revealed free intraperitoneal air (pneumoperitoneum), raising suspicion of gastrointestinal perforation. An emergency exploratory laparotomy was performed. Intraoperative findings revealed purulent peritoneal fluid and a perforation on the posterior wall of the uterus, with the IUD visibly protruding through the uterine serosa. The IUD was surgically removed, and the perforation could not be primarily repaired, and we performed a total hysterectomy. No gastrointestinal pathology was found. The patient recovered well postoperatively.Conclusion: This case highlights the importance of considering IUD-related uterine perforation in the differential diagnosis of acute abdomen and pneumoperitoneum, even in elderly patients. Timely diagnosis and surgical management are essential to avoid life-threatening complications. Regular follow-up of IUD users, especially postmenopausal women, is critical for early detection of delayed complications.