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Heterotopic pregnancy, defined as the coexistence of an intrauterine pregnancy and an extrauterine pregnancy.  It is a rare entity and theoretically occurs at an incidence of 1 in 30 000 pregnancies (2,3,12). The rise in the incidence of tubal and pelvic diseases has contributed to an increasing rate of heterotopic pregnancies. This rise can also be attributed to the increasing use of assisted reproductive technology such as In Vitro Fertilization (IVF) and Gamete intra-fallopian transfer (GIFT) (2,3,11,12).  After assisted reproductive technology procedures, the incidence of heterotopic pregnancy is at a concerning 1 in 100 pregnancies (2,12).

The treatment of heterotopic pregnancy aims to maintain the intrauterine pregnancy while removing the extrauterine pregnancy using a minimally invasive method (1). The treatment modalities for heterotopic pregnancy can be divided into surgical and non-surgical treatments. Non-surgical treatments involve the direct administration of drugs, such as potassium chloride, methotrexate, and hyperosmolar glucose to the extrauterine gestational sac under ultrasonographic or laparoscopic guidance (10,11).  Systemic management of these agents is difficult because these treatments can result in termination of both the desirable intrauterine and unwanted extrauterine pregnancy (7).  Surgical management, particularly laparoscopic surgery, has a shorter operating time, faster recovery, and less postoperative pain compared with those of laparotomy.

As seen in our patient, heterotopic pregnancy is a difficult entity to diagnose, often leading to the late detection of an extrauterine sac (2).  Our patient is a 36-year-old who has been trying to get pregnant for 2 years.  Because of the information available a diagnosis of acute appendicitis in pregnancy was made. There were no clear signs of a ruptured ectopic pregnancy despite ultrasonography been done. An emergency laparoscopic procedure was done highlighting the underlining pathology.