Bilateral tubal pregnancy (BTP), a rare form of ectopic pregnancy, occurs in 1/200,000 pregnancies and typically follows assisted reproductive techniques (ARTs). We report a case of spontaneous BTP in a 34-year-old woman presenting with acute abdomen and no prior history of ART. The diagnosis was established 27 days after initial presentation via transvaginal ultrasonography and elevated beta human chorionic gonadotropin (beta-HCG). Following diagnostic laparoscopy, bilateral salpingectomy was performed. This case highlights the possibility of BTP, emphasizing the need to carefully inspect the contralateral adnexa when treating a “unilateral” ectopic pregnancy.