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Introduction: Heterotopic pregnancy is the coexistence of intrauterine pregnancy (IUP) and extrauterine gestation. It is a rare and dangerous life-threatening situation that is difficult to diagnose and easily missed. The incidence in the general population is estimated to be 1 in 30,000. Risk factors for ectopic pregnancy are pelvic inflammatory disease (PID), tubo-ovarian abscess (TOA), previous ectopic pregnancies, or previous surgery. Case: A 22 year old gravida 2 para 1-0-0-1 presented to the emergency department (ED) and was diagnosed with heterotopic pregnancy despite lack of any notable risk factors. Transvaginal ultrasound showed live IUP and right ovarian/adnexal ectopic pregnancy with heartbeat, along with moderate hemoperitoneum. She underwent operative laparoscopy and right salpingectomy, being discharged home on post-operative day 1 with a stable hemoglobin concentration. She delivered the IUP at 38 weeks 5 days gestation via spontaneous vaginal delivery. Discussion: This case represents a spontaneous heterotopic pregnancy in a 22-year-old patient with no previous risk factors identified and demonstrates laparoscopy as a successful treatment modality for heterotopic pregnancy.