Cesarean scar pregnancy (CSP) is a rare location of an ectopic pregnancy implanted within a scar from previous cesarean section, separated from the endometrial cavity. The prevalence ranges from 1:1,800 to 1:2,226 pregnancies. It is a potential life-threatening condition, and if misdiagnosed, can cause serious maternal morbidity from uterine rupture with massive hemorrhage and even death. Until now, no universal treatment guidelines have been established, with treatment options ranging from systemic or local injection of methotrexate (MTX), suction curettage under ultrasound control to surgical treatment, including hysteroscopy and wedge resection of the ectopic pregnancy, via laparotomy or laparoscopy. The authors present a case of a 42-year old woman with two consecutive CSPs. First CSP was unsuccessfully treated conservatively, followed by ultrasound guided vacuum aspiration of the uterine cavity. Second CSP was treated by laparotomy and a wedge excision of a CSP and repair of a scar with interrupted sutures. The authors also discuss diagnostic pitfalls and treatment modalities.