Background: Vital twin tubal gestation is a rare complication in pregnancy.
Case: An asymptomatic gravida 1 female presented with increasing beta-HCG levels without an intrauterine gestation. Doppler sonography revealed cardiac motion of unilateral tubal twins. The patient was treated laparoscopically by partial tubectomy allowing a subsequent tubal re-anastomosis.
Conclusion: Doppler sonography may detect vital ectopic pregnancies early enabling fertility-conserving surgery.