Tubal sterilization is considered a permanent method of contraception because it is highly effective in preventing pregnancy and therefore failure is rare. The likely hood of ectopic pregnancy occurring is increased when pregnancy occurs after sterilization. In this paper, we report the case of a 38 year old para 3 +1 , 3 alive that had bilateral tubal ligation during her third caesarean section for delivery of her last child three years prior to presentation. She presented with 10 weeks history of amenorrhoea and 6 weeks history of lower abdominal pain. She subsequently had laparotomy for left ruptured ectopic pregnancy. Clinicians should always consider the diagnosis of ectopic pregnancy in any woman of reproductive age presenting with lower abdominal pain and amenorrhea even if she has had tubal sterilization. Women who have had bilateral tubal ligation should be counseled on the remote chance of failure and the need to present early if they have symptoms and signs suggestive of pregnancy.