A 32-year-old Thai woman presented with acute severe lower abdominal pain and 8 weeks of amenorrhea. The patient was hypotension, had anemia and signs of lower abdominal peritonitis. Initial diagnosis was tubal pregnancy with rupture. Intraoperatively, there were hemoperitoneum and two fetuses were found in the pelvis. Final diagnosis of ruptured unilateral twin tubal pregnancy was achieved. A right salpingectomy was done. There was no immediate complication.
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