Background: Abdominal pregnancy is a rare variety of ectopic pregnancy. It is associated with a very high maternal and perinatal morbidity and mortality. Case: A rare case of an unsuspected 16–18 weeks' secondary abdominal pregnancy with positive cardiac activity and diagnosed only at laparotomy is being reported. Prior to surgery, this case was misdiagnosed as a rudimentary horn pregnancy. The difficulties encountered during surgery and their subsequent management are discussed. A brief review of literature is also presented. Conclusions: The diagnosis and treatment of the varied presentations of abdominal pregnancies is extremely difficult, posing a serious obstetric dilemma. Periodic review of all reported cases is essential for all obstetric practitioners who may otherwise be unprepared to properly manage this ominous pregnancy complication. (J GYNECOL SURG 26:211)
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