Cesarean scar pregnancy (CSP) is defined as a condition where the product of gestation implants into the myometrial defect of a previous uterine incision and is increasingly becoming a common pathology due to the rise in cesarean deliveries. It is the most uncommon form of ectopic pregnancy and is difficult to diagnose and treat. These pregnancies can be associated with adverse maternal outcomes like rupture of the uterus, severe obstetric hemorrhage, and morbid implantation of the placenta. Cesarean scar pregnancy is considered precursor to the development of the morbidly adherent placenta and two primary risk factors are previous cesarean section and placenta previa. Cesarean scar pregnancies have been classified into two types. In the first type the gestational sac (G Sac) implants on the scar and progresses towards either the cervical-isthmic space or the endometrial cavity. This condition may result in live birth but with a major risk of severe hemorrhage at the area of implantation. In type II CSP, implantation occurs deeply into the defect of a prior lower segment cesarean section (LSCS) scar and further advances to involve the muscle and the serosal layer of the uterus. We examine a particular case of type II CSP where the diagnosis was initially delayed. Our patient, a G5P4A1L4 woman in her mid-forties with a history of two LSCSs, presented with severe lower abdominal pain, 2 months of amenorrhea, and a positive urine pregnancy test. An urgent ultrasound with a Doppler scan confirmed a cesarean scar ectopic pregnancy. The decision was made to forgo an magnetic resonance imaging (MRI) due to non-affordability and also because ultrasound with Doppler flow imaging, is the standard modality for diagnosing CSP. The preferred imaging modality is transvaginal scanning, which gives detailed information about the implantation site and its distance from the LSCS scar. A thorough abdominal scan conducted with a full bladder allows the determination of the gap between the G Sac and the urinary bladder. The patient received comprehensive counseling on the diagnosis, management options, and associated risks, and chose to undergo a total laparoscopic hysterectomy with bilateral salpingectomy. The surgery was made complex by intraperitoneal adhesions resulting from two prior surgeries, and the bladder was firmly attached to the uterus. Careful adhesiolysis, precise identification of ureters, coagulation of the uterine vessel pedicles at their origin, and impeccable hemostasis led to a successful surgical outcome without any unintended complications. The patient benefitted from early recovery and minimal blood loss. She was discharged on postoperative day two and the histopathology reports confirmed the diagnosis of CSP.