Heterotopic pregnancy (HP) is defined as the simultaneous occurrence of intrauterine and extrauterine pregnancy. It is considered as a rare entity prior to the advancement of assisted reproductive technology (ART). This paper reports a case of 35 year-old female patient who presented HP in a natural cycle with intrauterine device. A diagnosis of acute abdomen with intrauterine pregnancy was made on ground of preoperative evaluation and laparotomy was performed. Salpingostomy and hematoma drainage were performed. HP diagnosis is still troublesome despite the improved techniques. In view of the increasing incidence of HP due to tubal damage and the use of ART, a high index of clinical suspicion is required to detect and manage this clinical presentation. Ultrasound performed by experienced radiologist is important in making an early diagnosis of HP. The treatment option of HP should aim to terminate the extrauterine gestation with minimal distress to the intrauterine pregnancy. Choice of treatment for HP depends on the clinician's surgical experiment as well as the patient's hemodynamic condition.