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Background: Heterotopic pregnancy is simultaneous occurrence of intrauterine and extra uterine pregnancy. It is a rare condition, diagnosed in 1 per 30,000 unassisted conceptions. In most cases diagnosis is made after rupture of the extrauterine pregnancy.
Case summary: Here we report, a rare case where a 25 years old primigravida at 8 weeks of gestation presented with acute abdomen. She had no risk factors for ectopic pregnancy. She visited multiple health facilities and ultrasound examinations with unsettled diagnosis. Finally the diagnosis of heterotopic pregnancy was considered based on clinical and ultrasound findings and confirmed by laparatomy.
Conclusion: We report this case to highlight the possibility of heterotopic pregnancy without any risk factor. The presence of an intrauterine pregnancy should not be taken as evidence to exclude the possibility of ruptured ectopic pregnancy from the differential diagnosis of acute abdomen in reproductive aged women.