Women in the reproductive age group presenting in an emergency with acute pelvic pain is a frequent gynaecological condition. Various differential diagnoses including non-gynaecological causes should be kept in mind while assessing the case. Most common gynaecological causes of acute pelvic pain include ruptured ectopic pregnancy and ruptured haemorrhagic corpus luteal cyst. Meticulous history taking, clinical examination, and laboratory workup is required to confirm the diagnosis and timely intervention is needed to reduce maternal morbidity and mortality. Hereby, I would discuss a case of spontaneous rupture of haemorrhagic corpus luteal cyst in a post mitral valve replaced patient on an oral anticoagulant. Case: A 22-year-old woman with 3 abortions, no live issues, known case of Rheumatic Heart Disease (Mitral Stenosis), Mitral Valve Replacement done in 2012, the patient was on oral warfarin, presented in casualty with acute pain in the lower abdomen, nausea and vomiting with tachycardia with no history of amenorrhoea. Diagnosis: Initial Blood investigations were within normal limits and transabdominal ultrasonography was suggestive of right ovarian tumour with benign neoplastic etiology. Intervention: Initially the patient was managed conservatively, later her condition deteriorated with tachycardia and hypotension with free fluid in the abdomen when she was taken for emergency exploratory laparotomy with transfusion of required blood products keeping in mind the oral anticoagulant and not to overload the patient. Persistent tachycardia in the postoperative period despite adequate replacements leads to her evaluation of thyroid profile when she was diagnosed as hyperthyroidism and was started on medications when her condition improved tremendously. The patient recovered well post-op. Conclusion: The patient with acute abdomen should be evaluated for all the differential diagnoses, primarily excluding pregnancy and other non gynaecological conditions. Timely diagnosis and management can save a patient__ampersandsignrsquo;s life.