A ruptured omphalocele is a very rare complication in conjoined twins. Some cases have prompted emergency neonatal separation of the twins with varying results. We report a case of ruptured omphalocele in a thoraco-omphalopagus twin managed by primary repair of the defect at the University of Nigeria Teaching Hospital, Enugu. The twins later had a successful elective separation. Challenges of managing this case in our setting and the advantages of avoiding emergency neonatal separation are highlighted.