Introduction: Heterotopic pregnancy is a rare clinical condition where both intrauterine and extra uterine pregnancy coexists. In a spontaneous conception, the diagnosis is difficult to make, but an important one to consider in the presence of acute abdominal pain, hemorrhagic shock, and intrauterine pregnancy. Case Report: A 28-year-old G4P0+4 with a family history of multiple gestation who presented with acute abdomen and haemorrhagic shock at a gestational age of nine weeks and five days. The diagnosis of ruptured ectopic pregnancy coexisting with viable intrauterine gestation was made with ultrasound findings as well as clinical features necessitating emergency exploratory laparotomy. Ethical approval was obtained from the ethics and research committee of Federal Teaching Hospital Abakaliki. Successful treatment of ectopic pregnancy with uneventful convalescence and viable intrauterine pregnancy delivered at term. Conclusion: Obstetricians should keep a high index of suspicion of heterotopic pregnancy among women of reproductive age, especially