The relationship between pelvic actinomycosis and the presence of an intrauterine device is well known. Abdominal wall actinomycosis with no involvement of pelvic organs in the presence of an intrauterine device is extremely rare. We report a case of a 32-year-old woman with a long-standing intrauterine device who developed abdominal wall actinomycosis. The diagnosis was established late by histopathological examination after an initial surgical procedure during which the abscess was evacuated and all the necrotic tissue was excised. Postoperatively, the patient developed two intra-abdominal abscesses, which were treated by surgical drainage. The combination of long-term high-dose antibiotic therapy with surgery led to successful management of the condition. We highlight the difficulty in diagnosis, necessity for an early postoperative diagnosis, and the importance of high-dose intravenous antibiotic therapy to prevent recurrence. Abdominal wall actinomycosis should be considered in intrauterine device users who present with abdominal abscesses of unknown origin.