Introduction: Mullerian anomalies occur owing to developmental defect at various stages. They range from Mullerian agenesis to mild arcuate uterus. Lateral fusion defect results in the formation of the rudimentary horn of the uterus. Incidence of rudimentary horn pregnancy is known to occur in 1/100,000 and 1/140,000 pregnancy. Aims: To evaluate a case of the second trimester ruptured rudimentary horn pregnancy Methodology: A 23-year-old primigravida at 18 weeks 4 days gestation presented in shock with gross hemoperitoneum. Results: Prompt intervention with exploratory laparotomy with excision of the rudimentary horn with massive blood transfusion and ventilatory support was lifesaving. The patient conceived spontaneously 4 months of laparotomy and gave birth to a term male baby by caesarean section. Conclusion: Uterine anomalies though rare must be kept in differential diagnosis for any pregnant women presenting with shock and hemoperitoneum as early diagnosis and management can result in a better outcome.