A 38-year-old woman, gravida 5, para 1, abortion 2, with a history of secondary infertility and salpingectomy for an ectopic pregnancy, was referred for a suspicion of a pregnancy developing in a rudimentary cornua at 13 weeks' gestation. She was completely asymptomatic. Physical examination revealed stable vital signs while bimanual examination revealed an enlarged uterus with no adnexal masses. Transvaginal ultrasound revealed a gestational sac with a heartbeating fetus along with measurements corresponding to 13 weeks' gestation. The endometrial cavity was quite near in the right cornual region, but there was no evident communication between them. Both the endometrium and gestational sac appeared to be surrounded by myometrium. The diagnosis of intramural pregnancy was suspected and a Magnetic Resonance Imaging (MRI) was indicated. It revealed a gestational sac with a fetus developing inside the fundic uterine wall (Figure 1). The placenta seemed to invade the myometrium (Figure 2).
A uterine artery embolization (UAE) was selected in order to reduce bleeding during laparotomy. While preparing the patient for embolization, she developed signs suggesting an acute abdomen (diffuse distention and tenderness and rebound tenderness on abdominal examination) and a hypovolemic shock. An emergency laparotomy was performed. About 300 mL of blood and clot was detected, the uterus was ruptured, and the placenta was actually percreta but did not invade any abdominal organ. The fetus was still in the gestational sac. Enucleation and removal of the gestational sac then padding of the residual myometrial cavity were performed. Trophoblastic tissue was removed easily, and we did not need to perform any myometrial resection or subtotal hysterectomy. She had a satisfactory recovery.