This report presents a case of sigmoid perforation five years after insertion of a Nova-T. This case illustrates that serious complications of third generation IUDs may occur even after several years of intraabdominal location. An IUD, which has perforated the uterus, cannot be left in the peritoneal cavity. Therefore, removal of a perforated IUD is still a medical indication as recommended by the World Health Organization and IPPF International Medical Advisory Panel Meetings.