This case demonstrates a rare complication of the use of IUCD's - even more so for the fact the patient has synchronous correctly and incorrectly sited IUCD's.

A new IUCD must have been inserted after the prior one was 'lost' .  Clinically no strings evident per vaginum and not visible on ultrasound.  The assumption being it had been lost per vaginum, not that it had undergone perforated the uterine wall and migrated into the peritoneal space.