Background: Cesarean scar ectopic pregnancy is a serious condition requiring prompt intervention. While some patients may be asymptomatic, symptoms can include severe abdominal pain, vaginal bleeding, and, in severe cases, uterine rupture, hemoperitoneum, and Disseminated Intravascular Coagulation (DIC). The primary risk factor is a previous cesarean section, though other factors such as impaired wound healing from preterm cesarean sections or infections like chorioamnionitis can also increase risk. Although less common, this condition can occur following uterine procedures such as myomectomy or curettage. At present, no specific guidelines exist for managing cesarean scar ectopic pregnancies, and treatment strategies are often adapted from protocols for other ectopic pregnancies. Methods/Results: We present the case of a 29-year-old woman who reported irregular spotting and vaginal bleeding lasting 7 days. Her medical and surgical history was otherwise unremarkable, except for a previous cesarean section at 37 weeks due to fetal distress during induction for an IUGR fetus with trisomy 21. Diagnosis revealed a gestational sac at the site of the previous surgical scar with embryonic echoes. Non-surgical treatments such as intramuscular Methotrexate and a single oral dose of 600 mg Mifepristone were unsuccessful. We then approached the double-balloon technique (CRB balloon, Cook) under spinal anesthesia in the operating theatre, using ultrasound guidance. The procedure was completed without complications. Conclusion: Follow-up included monitoring serum Beta-human Chorionic Gonadotropin (?-hCG) levels until they returned to non-pregnant levels, and an ultrasound at 30 days confirmed the resolution of the pregnancy. Sharing cases like this, along with the different approaches and outcomes, may help in developing practical guidelines for managing cesarean scar ectopic pregnancies.