This case report describes a rare occurrence of spontaneous bilateral ectopic pregnancy (BEP) in a woman in her 30s, at approximately 7 weeks of gestation in Western Uganda. The patient presented with worsening lower abdominal pain, light vaginal bleeding and vomiting. Initial transvaginal ultrasound suggested a unilateral ectopic pregnancy; however, subsequent imaging and intraoperative findings confirmed bilateral ampullary ectopic pregnancies, one of which had ruptured. This woman had a recent diagnosis of HIV on antiretroviral therapy; she otherwise had no history of assisted reproductive technologies or other risk factors. This case highlights the diagnostic challenges of BEP, emphasising the importance of thorough adnexal evaluation during imaging and intraoperative assessment. The report contributes to existing literature by discussing risk factors and management strategies while advocating for heightened clinical awareness, especially in resource-limited settings. A modified algorithm is attached to guide clinical decision-making regarding suspected BEP. .