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Introduction Unilateral twin ectopic pregnancies are exceedingly rare, occurring in one in every 250,000 pregnancies. While clear guidelines exist regarding the management of singleton ectopic pregnancies, no such recommendations exist for multi-gestational ectopic pregnancies. Case presentation A 36-year-old woman, gravida 3 para 1, presented to the emergency department at 6 weeks and 4 days of gestation with a live twin ectopic pregnancy diagnosed on a dating ultrasound scan. Given the high likelihood of rupture, she underwent a laparoscopic salpingectomy and was discharged home the following day. The patient was followed-up with weekly serum β-hCG tests, to ensure there was no remaining pregnancy. Discussion While the morbidity and mortality associated with singleton ectopic pregnancies has gradually declined, the risk of rupture is higher in twin ectopic pregnancies and rupture is estimated to occur in 30–50% of cases. Surgical intervention remains the mainstay of treatment for these pregnancies.

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