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In the setting of a known ectopic pregnancy, severe abdominal pain with clinical concern for rupture is an indication for emergency surgery. In rare cases, appendiceal pathology may occur simultaneously.A woman with a known ectopic pregnancy presented to the emergency department with a clinical picture consistent with its rupture. At the time of surgery, an appendectomy also was performed owing to concern for concurrent appendicitis; histopathologic examination revealed appendiceal endometriosis.During surgical management of ectopic pregnancy, it is important to undertake a thorough examination of the pelvis, because patients may present with multiple concurrent pathologies. In the setting of an emergency operation, when the diagnosis seems clear, this survey should not be forgotten.