rate of 44 per minute and blood pressure of 80/40 mmHg. There was tenderness and guarding on abdominal palpation. The initial hemoglobin was 4.1g/dl. Vigorous resuscitation was started; a bedside ultrasound showed a viable intrauterine pregnancy equivalent to seven weeks gestation with a left-sided adnexal mass and significant amount of free fluid in the pelvis. The patient was taken immediately to the operating room for exploratory laparotomy which revealed a hemo-peritoneum of 2.2 liters of blood and blood clots, a left ovarian mass of 9x10 cm, twisted twice around the ovarian pedicle with a ruptured capsule and actively bleeding from the base (Figure 1). There was soft and velvety tissue inside the ruptured cyst (Figure 2). The left tube was twisted at the cornu and stretched over the mass. The left ovarian pedicle was clamped to control the bleeding and as there was no suspicion of malignancy macroscopically, left salpingo-oophorectomy was performed.