Ruptured Rudimentary Horn Pregnancy and the Missing Hemoperitoneum: An Unexpected Presentation

Background: Pregnancy in the rudimentary horn of a unicornuate uterus is an extremely rare obstetric complication and usually results in rupture in the second trimester, with an acute clinical presentation. The authors present a rare case of a ruptured rudimentary horn pregnancy (RHP) without classical hemoperitoneum. Case: A 22-year-old primigravida at 21 weeks gestation was referred as a case of intrauterine fetal death. Magnetic resonance imaging indicated a possible rudimentary horn rupture. Results: Intraoperatively, it was noted that there was a ruptured right RHP with a macerated fetus, and 100 cc of clotted blood was contained in a pseudosac formed by the surrounding viscera and peritoneum. After surgical intervention, the patient had an uneventful postoperative period. Conclusion: A ruptured RHP can occur unexpectedly with stable hemodynamics. (J GYNECOL SURG 20XX:000)