A 54-year-old asymptomatic postmenopausal woman was found to have a deep myometrial deposit with suspected serous spread by ultrasound during scheduled removal of a V-shaped intrauterine device (IUD). During the hysteroscopy, extreme resistance to traction occurred, which led to immediate conversion to laparoscopy. Laparoscopy revealed a double perforation of the uterus: one arm of the IUD was embedded in the pelvic peritoneum near the left ureter and the other in the right tubal isthmus. Bilateral salpingectomies were performed and the IUD was safely removed through the uterine cavity with hysteroscopic guidance. The postoperative course was without complications. The article states that in China, retained IUDs are common after menopause, but may lead to silent complications due to uterine atrophy and rigid structures. Ultrasound may underestimate ectopic involvement, and extreme tractional resistance at hysteroscopy necessitates conversion to laparoscopy. A combined hysteroscopic-laparoscopic strategy enables safe removal while protecting organs such as the ureter and fallopian tubes.