Cornual pregnancy is an uncommon rare variant of ectopic pregnancies. Its diagnosis is challenging. Ruptured cornual pregnancy is still encountered nowadays with a very high consequent morbidity and mortality.

We hereby report the case of a ruptured ectopic cornual pregnancy with positive fetal heart that presented with initial hemodynamic stability and that was misdiagnosed on ultrasound to be an abdominal pregnancy in a thirtythree-year-old lady, that was previously operated of two laparotomies. In the presence of free intraabdominal fluid reaching the Morrison’s pouch diagnostic and therapeutic laparoscopy was done and intraoperatively a ruptured cornual ectopic pregnancy is diagnosed and a right cornual resection with ipsilateral salpingectomy are performed after conversion into laparotomy due to operational difficulties and intraabdominal active bleeding.

The ruptured ectopic cornual pregnancy is a situation that should be prevented via an exhaustive first trimester ultrasound examination. The ultrasound remains a helpful but not conclusive tool in the diagnosis of this condition.