Ectopic pregnancy foci might not be recognized despite advanced gestational ages and might present with life threatening symptoms like sudden rupture and acute abdomen. We report a triplet heterotopic pregnancy case with acute abdomen symptoms. The patient had both an intrauterine alive twin pregnancy at 9+5 weeks gestation and also tubal ectopic pregnancy. The pregnancy was achieved after ovulation induction with recombinant gonadotropin and intrauterine insemination. In conclusion, despite the presence of a demonstrated intrauterine viable pregnancy, pelvic examination and scanning must be performed in all asymptomatic pregnant women in order not to overlook ectopic pregnancy cases.