Unusual clinical course Background: Ectopic pregnancy after hysterectomy is extremely rare, and the diagnosis can be challenging, even with modern imaging methods. A rare case is presented of ectopic tubal pregnancy in a 28-year-old woman that presented eight years following a hysterectomy. Case Report: A 28-year-old woman was admitted in our hospital with moderate hypogastric pain, mild vaginal bleeding, and bilateral mastalgia. She had undergone hysterectomy eight years previously for postpartum hemorrhage. Pelvic ultrasound showed a heterogeneous tissue mass in the pelvis with peripheral vascularity that was also seen on magnetic resonance imaging (MRI). Laboratory tests showed increased serum levels of human chorionic gonadotropin (hCG). Following hospital admission, she developed an acute abdomen and shock due to tubal rupture and an emergency salpingectomy was performed. Conclusions: A multidisciplinary approach to diagnosis and management facilitated an accurate and timely diagnosis in a rare case of ectopic pregnancy that presented eight years following hysterectomy, but could not prevent the development of potentially life-threatening complications.