Recanalzation at the site of tubal ligation is one of the causes of the failure of such a procedure. The underlying factor could be a pre-existing proliferative disease of the tube, i.e. salpingitis isthmica nodosa. The plexiform type of re-canalization that resulted in the presented case might the cause of the tubal pregnancy. The presence of amenorrhea and /or irregular uterine bleeding in a patient with tubal sterilization requires meticulous investigations to avoid the high morbidity rate associated with missed ectopic gestation. The use of HCG assays and laparoscopic evaluation could improve diagnostic ability in similar cases.