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We present a case of a woman in her 20s with right iliac fossa pain. Initial investigations showed mildly elevated inflammatory markers and serum beta human chorionic gonadotrophin (hCG) <1 mIU/mL. She was taken to theatres as a presumed early appendicitis but found to have haemoperitoneum with a free-floating cystic structure in the pouch of Douglas with intact pelvic organs. This was subsequently confirmed histologically as a gestational sac which had likely been expelled via the abdominal ostia into the peritoneal cavity (a so-called complete tubal abortion). She made a good postoperative recovery and was discharged with no complications. This case highlights the rare but important potential for ectopic pregnancy and its complications to be present despite a negative serum beta-hCG.