Ruptured ectopic pregnancy represents an emergency gynecological procedure. Performing the major cause of maternal death among first trimester pregnancies. Although the mortality incidence decreases, the incidence of ectopic pregnancy is constantly increasing. The simultaneously existence of endometrial and ectopic pregnancy represent a rare condition requiring specific treatment. In cases with severe anemia an urgent management is mandatory. We present a case of heterotopic pregnancy with tubal rupture accompanied with severe anemia successfully surgically treated.