Ectopic pregnancy is defined as implantation and subsequent development of an embryo outside the uterine lining. It has wide range of presentation from acute haemoperitoneum to chronic ectopic pregnancy. This is a case of chronic ectopic pregnancy with haematosalpinx which presented as an acute ruptured ectopic pregnancy. A 26 year old G3P2L1 with 6 weeks 5 days gestation presented to casually with complaints of lower abdominal pain for one day. Clinically the patient was haemodynamically stable with mild pallor. The abdomen was soft with diffuse tenderness. Uterus was bulky with fullness in the left fornix. Left fornicial tenderness and cervical motion tenderness was present. Ultrasound revealed a heterogenic mass in left adnexa. Left total salpingo-oophorectomy was done and histopathology revealed fallopian tube which was markedly oedematous in nature with areas of haemorrhage and blood vessels with bit of ovarian tissue.