To present a case report of a spontaneous, heterotopic, triplet conception of a patient without any risk factors.Case report.Community hospital in Park Ridge, Illinois.One patient, 30-year-old multigravida, sent to the emergency room for evaluation of right lower quadrant pain after confirmed identification of an early, intrauterine pregnancy by an office ultrasound. The patient was taken to the operating room for suspected appendicitis and found to have a right ruptured ectopic pregnancy with a normal appendix.The patient underwent a laparoscopic right salpingostomy with hydrodissection of the ectopic pregnancy.Follow-up pelvic ultrasounds confirmed a viable, spontaneous twin intrauterine pregnancy.The twin pregnancy continued without complications until 34 weeks' gestation, when the patient began preterm labor and delivered healthy twins.Even in the absence of infertility treatments and/or risk factors, heterotopic pregnancy should be included in the differential diagnosis for lower quadrant abdominal or pelvic pain.