Tanushree Sandipta Rath, So
Background: Mullerian duct anomalies in female result from failure of complete development of one duct and incomplete fusion of other duct during embryonic life. Bicornuate uterus with rudimentary horn (BURH) is the rarest uterine anomaly. Pregnancy in rudimentary horn is even rarer, i.e. 1:1,40,000 pregnancies. Case description: A 24-year-old primigravida presented with acute pain abdomen and amenorrhoea for 16 weeks. She was severely pale and was in hypovolemic shock, with diffuse tenderness, guarding and rigidity of abdomen. Per vaginal examination revealed a bulky uterus with motion tenderness and full fornices. On laparotomy there was hemoperitoneum along with rupture of left horn of the bicornuate uterus. The placenta was inside the rudimentary horn, and the horn was non-communicating with the body of the uterus. It was excised completely. An abortus of 16 weeks size was lying within intact membranes, and was found free within the abdominal cavity. Conclusion: A second trimester pregnancy with features of ruptured ectopic should be screened for the associated uterine anomalies. Rupture of the rudimentary horn of the uterus is one of the important but rare causes of acute abdomen. A high index of suspicion is warranted in cases of advanced gestation presenting with acute abdomen, especially in developing countries like India, where the possibility of early detection before rupture is unlikely, culminating in maternal demise.