•Congenital uterine anomalies like bicornuate uterus have various obstetric outcomes such as malpresentation, preterm labour, mid-trimester miscarriages and rarely uterine rupture in early pregnancy.

•Bicornuate uterus accounts for 25% of uterine anomalies.

•The incidence of uterine rupture in women with a bicornuate uterus is not well-documented.

•Uterine rupture is an obstetric emergency that leads to major haemorrhage and can cause mortality.

•32-year-old, Gravida 4 Para 3, unaware of pregnancy due to use of Jadelle. presented with severe abdominal pain with no vaginal bleeding.

•Her last delivery via caesarian section for malpresentation.

•She was semiconscious with distended abdomen

•Initial ultrasound suggested abdominal pregnancy at 16 weeks 6days.

•Emergency laparotomy: massive hemoperitoneum (~4.5L), ruptured right horn of a bicornuate uterus, a non-viable fetus weighing 400g  in abdominal cavity and a transverse lower uterine scar was seen on the left horn of the uterus.

•Surgical management: excision of ruptured right horn.

•In most cases, women with bicornuate uterus are asymptomatic.

•Diagnosis missed in previous surgery, right horn reported as fibroid.

•Diagnostic challenge: Mimics ectopic pregnancy, especially with irregular menses and no prior anomaly detection.

•One horn may remain underdeveloped and prone to rupture.

•Early ultrasound & 3D imaging crucial but often unavailable in low-resource settings.