Context: Patient attended at the Obstetric Center of the Hospital of Base Dr Ary Pinheiro with complaint of menstrual delay and pain in the direct iliac fossa with signs peritonitis. Objective: To report a clinical case. Methods: Medical records. Patient (s): Patient at 36 years of age, third pregnancy, being the first normal delivery and with a history of previous abortion, presented gestational age at 5 weeks and 4 days by the date of the last mentation. Intervention (s): During hospitalization carried out investigation procedure by imaging and surgical. Main result Measure (s): Performed laparotomy due to acute hemorrhagic abdomen. Outcome (s): Ultrasonography reports hemoperitoneum and ectopic pregnancy in left attachment and signs of endometriosis attached right. Conclusions: A patient admitted in a hospital of high complexity with signs of acute hemorrhagic abdomen without hemodynamic repercussion evolved to diagnose ectopic pregnancy associated to a focus of grade 4 endometriosis.