A 34-year-old African female, para 1, gravida 2, presented to the Accident and Emergency Department, having had symptoms of vomiting and abdominal pain for 3 days. The symptoms had worsened on the day of presentation to the hospital. She reported several episodes of vomiting with associated loose stools and abdominal fullness. She also had ongoing vaginal bleeding that had started 5 days prior to presentation. Two years prior, the patient had an uncomplicated insertion of LNG IUS by an obstetrician/gynecologist at the 8-week visit following a normal vaginal delivery. She had a normal pap smear done at the time of insertion. One year following insertion, she had a desire to conceive and was scheduled for removal of the LNG IUS device. The strings could not be seen, and the device could not be retrieved with alligator forceps. The patient was therefore sent for a pelvic ultrasound to locate the lost IUD. The device was not seen on ultrasound. The patient was, however, lost to follow-up until presentation with symptoms of ruptured ectopic pregnancy. She had no preexisting conditions or previous surgery. On physical examination she was in fair general condition and not pale. Her vital signs were a temperature of 37.6 °C, a blood pressure of 120/66 mmHg, pulse rate of 99 beats per minute, respiration rate of 18 breaths per minute, and oxygen saturation of 100% on room air. On abdominal examination she had tenderness on the left iliac fossa and suprapubic regions with absent bowel sounds. The rest of the systemic examination was normal. An impression of acute abdomen was made at this point. As initial treatment she was given intravenous fluids (Ringer’s lactate solution) 1-L bolus, as well as intravenous paracetamol and ondansetron for pain and vomiting, respectively. The initial investigations included a full blood count, which revealed a normal hemoglobin level of 13.2 g/dl, slightly elevated white cell count of 12.28 × 109 cells/L, and normal platelet count of 314 × 109 cells/L. She had a beta human chorionic gonadotropin (Hcg) level of 7721 mIU/ml. Urinalysis showed leucocytes 2+, nitrite negative, and blood 2+. Transvaginal ultrasound showed a 2.1 cm × 1.8 cm echogenic mass with central cystic area on the left adnexa. It had no internal or peripheral vascularity. There was marked pelvic echogenic free fluid with low internal echoes extending to the Morrison’s pouch. The uterus was anteverted and normal in size and shape with an endometrial thickness of 5.5 mm. A 1.9 cm cystic lesion was seen in the right ovary, which was likely a corpus luteum cyst. There was no gestational sac or intrauterine device seen within the endometrial cavity. These features indicated ruptured ectopic pregnancy. The diagnosis at this point was a ruptured left tubal ectopic pregnancy. The plan was to admit the patient for an emergency laparoscopy with possible left salpingectomy. The diagnosis and plan were explained to the patient, who signed an informed consent for the procedure. Group and cross match of one unit of packed red cells was ordered in case a transfusion would be required. The laparoscopy was done under general anesthesia in the Lloyd–Davis position. Cohen’s uterine manipulator was placed. Veress insufflation was performed, followed by insertion of a 10-mm primary trocar at the umbilicus. Entry and operating pressures were 20 mmHg and 15 mmHg, respectively. Two secondary ports were inserted under vision, 5 mm in the right iliac fossa and 12 mm in the left iliac fossa. On primary survey, LNG IUS was found embedded at the fimbrial end of the left fallopian tube. The LNG IUS was retrieved whole under vision through the 12-mm port. There was hemoperitoneum of 700 ml. A ruptured left ampullary ectopic pregnancy was identified by left salpingectomy using bipolar coagulation and scissors. A corpus luteum cyst was found on the right ovary with normal right fallopian tube. Suction and peritoneal lavage were performed, and hemostasis was confirmed. The specimen was retrieved through the 12-mm port and taken for histology. There was no sign of uterus perforation. The pouch of Douglas and rectum appeared normal. All trocars were removed under vision. The postoperative recovery of the patient was unremarkable. She was debriefed about the surgery and discharged the following morning. She went home on oral paracetamol and diclofenac for pain relief. The patient was reviewed in the gynecology outpatient clinic 2 weeks later. She was asymptomatic and doing well. Histology report confirmed left ectopic tubal gestation. She reported that she desired conception. Preconception counseling was done. She was put on daily folic acid (400 µg). The patient was advised to come to the hospital as soon as she missed a period or tested positive for pregnancy for an early pregnancy ultrasound to rule out another ectopic pregnancy. Three months later she presented at the early pregnancy clinic following 5 weeks of amenorrhea. A pelvic ultrasound was done that showed intrauterine pregnancy at 5 weeks gestation.