Retrorectal ectopic pregnancy is an extremely rare form of ectopic pregnancy. Early detection and treatment can prevent the risk of massive bleeding. The pathogenesis is unclear. Currently, only one case of retrorectal ectopic pregnancy treated with MTX has been reported. We report the second case of retrorectal ectopic pregnancy treated with laparoscopic surgery under real-time intraoperative ultrasound guidance, achieving complete resection with minimal trauma and rapid recovery. This approach offers new insights into the diagnosis and treatment of this condition.