Caesarean scar ectopic pregnancy is defined as the implantation of the blastocyst in a previous Caesarean scar. It is a rare type of ectopic pregnancy. The incidence is however rising due to the increasing rates of Caesarean sections as well as in-vitro fertilization embryo-transfer. It can be diagnosed early by ultrasound. This remains a challenge in lower middle income countries where the availability of high resolution ultrasound and the skill for such sonography may be lacking. Misdiagnosis or a delay in diagnosis often leads to poor treatment outcomes. We present a case of a gravida 3 para 2 + 0 who had laparotomy for a caesarean scar pregnancy and highlight the challenges associated with diagnosis and management of this rare ectopic pregnancy in a lower middle income country.