Background: Pregnancy in a noncommunicating rudimentary horn is extremely rare and usually terminates by rupture in second trimester of pregnancy. Thus, excision of the rudimentary horn is advised when it is diagnosed. Case: A 25-year-old woman, gravida 2, para 1+0, presented as a case of an acute abdomen. She had a rare case of an intact pregnancy that had reached 26 weeks of gestation in a noncommunicating rudimentary horn, and this was misdiagnosed by ultrasound as a case of a ruptured uterus. The rudimentary horn, with the pregnancy in situ, the right tube, and the right ovary were excised. The fetus was not alive by the time of this surgery. Results: The patient's postoperative period was uneventful, and she was discharged to go home 3 days after her surgery had occurred. Conclusions: Despite being rare, rudimentary-horn pregnancy should be suspected regardless of the fetus' gestational age. Rudimentary-horn pregnancy should also be considered as an unusual presentation of a ruptured uterus. Excision of the rudimentary horn remains the “gold standard” method for treating these patients. (J GYNECOL SURG 30:162)
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