Unilateral twin tubal pregnancy is an extremely rare condition with an estimated incidence of 1/20,000 to 250,000 (1). It represents a major health risk for reproductive age group women. We present to u a case of 40 yr female who presented with complaints of one and half month amenorrhea and pain abdomen to Gynaecologic OPD. She was G3P2L2 with previous two vaginal deliveries. She was hypothyroid but controlled on treatment. On evaluation a UPT was done which was positive. Her beta HCG levels were markedly elevated. On USG examination a twin live embryos were seen in left tube consistent with tubal twin ectopic. No free fluid was seen in POD. Patient was hemodynamically stable. She underwent laparoscopy which showed markedly distended tube with no evidence of rupture and left salpingectomy with right sided tubal ligation was done. (Figure1)